Hypogammaglobulinemia following cardiac transplantation: A link between rejection and infection

Mohamad H. Yamani, Robin K. Avery, Steven D. Mawhorter, James B. Young, Norman B. Ratliff, Robert E. Hobbs, Patrick M. McCarthy, Nicholas G. Smedira, Marlene Goormastic, David Pelegrin, Randall C. Starling

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Hypogammaglobulinemia (HGG) has been reported after solid organ transplantation and is noted to confer an increased risk of opportunistic infections. Objectives: In this study, we sought to assess the relationship between severe HGG to infection and acute cellular rejection following heart transplantation. Methods: Between February 1997 and January 1999, we retrospectively analyzed the clinical outcome of 111 consecutive heart transplant recipients who had immunoglobulin G (IgG) level monitoring at 3 and 6 months post-transplant and when clinically indicated. Results: Eighty-one percent of patients were males, mean age 54 ± 13 years, and the mean follow-up period was 13.8 ± 5.7 months. Patients had normal IgG levels prior to transplant (mean 1137 ± 353 mg/dl). Ten percent (11 of 111) of patients developed severe HGG (IgG < 350 mg/dl) post-transplant. The average time to the lowest IgG level was 196 ± 125 days. Patients with severe HGG were at increased risk of opportunistic infections compared to patients with IgG > 350 mg/dl (55% [6 of 11] vs 5% [5 of 100], odds ratio = 22.8, p < 0.001). Compared to patients with no rejection, patients who experienced three or more episodes of rejection had lower mean IgG (580 ± 309 vs 751 ± 325, p = 0.05), and increased incidence of severe HGG (33% [7 of 21] vs 2.8% [1 of 35], p = 0.001). The incidence of rejection episodes per patient at 1 year was higher in patients with severe HGG compared to patients with IgG >350 (2.82 ± 1.66 vs 1.36 ± 1.45 episodes/patient, p = 0.02). The use of parenteral steroid pulse therapy was associated with an increased risk of severe HGG (odds ratio = 15.28, p < 0.001). Conclusions: Severe HGG after cardiac transplantation may develop as a consequence of intensification of immunosuppressive therapy for rejection and hence, confers an increased risk of opportunistic infections. IgG level may be a useful marker for identifying patients at high risk.

Original languageEnglish (US)
Pages (from-to)425-430
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume20
Issue number4
DOIs
StatePublished - Apr 26 2001
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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