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eight long-answer questions, four yes/no questions, and three checkbox questions focused on IgG measurement and HG treatment practices pre-and post-lung transplant. We sent the survey to 50 physicians at 40 transplant centers internationally using Google Forms on February 4 th , 2020. Results: There were 24 (48%, 24/50) respondents from 19 lung transplant centers. Responses were tabulated for individual respondents as answers varied within centers. Respondents reported routinely measuring IgG levels in 54% (13/24) of pre-transplant patients and 38% (9/24) of post-transplant patients, with time points for checking IgG levels varying widely. In post-transplant patients with frequent infections, respondents reported routinely measuring IgG levels (83%, 20/24), routinely not measuring (13%, 3/24), or not having a protocol (4%, 1/24). Reported criteria for initiating IgG replacement therapy (IgG-RT) were infection frequency only (n=2), IgG level only (n=6), or some combination of the two (n=9). IgG level cutoffs utilized to initiate IgG-RT ranged from <300 mg/dL to <600 mg/dL. Despite 41% (9/22) of respondents reporting they did not feel HG patients were being successfully identified and treated, 50% (11/22) reported patients were never referred to allergy/immunology. Reported barriers to screening and management centered around insurance-related issues (32%, 7/22), IgG-RT shortages (14%, 3/22), and distribution issues (14%, 3/22), and lack of evidence-based treatment protocols (32%, 7/22). Conclusion: HG screening and management practices in lung transplant recipients vary greatly, potentially leaving patients vulnerable to worse clinical outcomes. Reported barriers include lack of guidance regarding HG treatment criteria and difficulties obtaining IgG-RT. Involving immunologists in screening and treatment decision-making could mitigate some of these barriers.

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