Low pretransplant IgA level is associated with early post–lung transplant seromucous infection

Objectives: Infection is an important cause of morbidity and mortality after lung transplantation. Immunoglobulins are part of both seromucous (IgA) and serum (IgG) infection defense mechanisms. We therefore hypothesized that lower pretransplant IgA levels would be associated with more early post–lung transplant seromucous infections and greater mortality independent of IgG. Methods: From January 2000 to July 2010, 538 patients undergoing primary lung transplantation had pretransplant IgA (n = 429) and IgG (n = 488) measured as a clinical routine. Median IgA was 200 mg·dL⁻¹ (2% < 70 mg·dL⁻¹, lower limit of normal); median IgG was 970 mg·dL⁻¹ (5% < 600 mg·dL⁻¹). Intensive microbiology review was used to categorize infections and their causative organisms within the first posttransplant year. Results: In total, 397 seromucous infections were observed in 247 patients, most bacterial. Although IgA and IgG were moderately correlated (r = 0.5, P <.0001), low pretransplant IgA was a strong risk factor (P =.01) for seromucous infections, but pretransplant IgG was not (P ≥.6). As pretransplant IgA levels fell below 200 mg·dL⁻¹, the risk of these posttransplant infections rose nearly linearly. Lower pretransplant levels of IgA were associated with greater posttransplant mortality to end of follow-up (P =.004), but pretransplant IgG was not (P ≥.3). Conclusions: Low levels of preoperative IgA, an important immunoglobulin involved in mucosal immunologic defense, but not IgG, are associated with seromucous infections in the year after lung transplantation and increased follow-up mortality. It would appear prudent to identify patients with relative IgA deficiency at listing and to increase vigilance of monitoring for, and prophylaxis against, seromucous infection in this high-risk population.