Bronchiolitis obliterans syndrome, hypogammaglobulinemia, and infectious complications of lung transplantation

Chambers, Daniel C.; Davies, Belinda R.; Mathews, Ann; Yerkovich, Stephanie T.; Hopkins, Peter

doi:10.1016/j.healun.2012.10.006

Cited by 30 publications

(23 citation statements)

References 20 publications

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“…PVS has been associated with lymphocytopenia in stem cell transplantation . Low IgG and IgA levels in LTRs have recently been associated with fungal and viral infections, respectively . IgA levels were not measured in our study.…”

Section: Discussioncontrasting

confidence: 59%

Clinical features and outcomes of influenza infections in lung transplant recipients: a single‐season cohort study

Schuurmans

Isenring

Jungo

et al. 2014

Transplant Infectious Dis

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Section: Discussioncontrasting

confidence: 59%

Clinical features and outcomes of influenza infections in lung transplant recipients: a single‐season cohort study

Schuurmans

Isenring

Jungo

et al. 2014

Transplant Infectious Dis

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“…[9] A recent study in pediatric lung transplant recipients found an association between HGG and the risk of infections and hospitalization. [16] More recently, lower post-transplant IgG levels were associated with an increased risk of BOS [6].…”

Section: Discussionmentioning

confidence: 99%

“…[6], [7], [8], [9] A recent meta-analysis suggested that severe HGG after solid organ transplantation is associated with an increased risk of early infection and all-cause mortality. [10] In one study of lung transplant recipients, HGG was identified in 70% of lung transplant recipients, of whom 50% had very low immunoglobulin G (IgG) levels (<400 mg/dL).…”

Section: Introductionmentioning

confidence: 99%

Intravenous Immunoglobulin for Hypogammaglobulinemia after Lung Transplantation: A Randomized Crossover Trial

et al. 2014

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BackgroundWe aimed to determine the effects of treatment with intravenous immunoglobulin on bacterial infections in patients with hypogammaglobulinemia (HGG) after lung transplantation.MethodsWe performed a randomized, double-blind, placebo-controlled two-period crossover trial of immune globulin intravenous (IVIG), 10% Purified (Gamunex, Bayer, Elkhart, IN) monthly in eleven adults who had undergone lung transplantation more than three months previously. We randomized study participants to three doses of IVIG (or 0.1% albumin solution (placebo)) given four weeks apart followed by a twelve week washout and then three doses of placebo (or IVIG). The primary outcome was the number of bacterial infections within each treatment period.ResultsIVIG had no effect on the number of bacterial infections during the treatment period (3 during IVIG and 1 during placebo; odds ratio 3.5, 95% confidence interval 0.4 to 27.6, p = 0.24). There were no effects on other infections, use of antibiotics, or lung function. IVIG significantly increased trough IgG levels at all time points (least square means, 765.3 mg/dl during IVIG and 486.3 mg/dl during placebo, p<0.001). Four serious adverse events (resulting in hospitalization) occurred during the treatment periods (3 during active treatment and 1 during the placebo period, p = 0.37). Chills, flushing, and nausea occurred during one infusion of IVIG.ConclusionsTreatment with IVIG did not reduce the short-term risk of bacterial infection in patients with HGG after lung transplantation. The clinical efficacy of immunoglobulin supplementation in HGG related to lung transplantation over the long term or with recurrent infections is unknown.Trial RegistrationClinicaltrials.gov NCT00115778

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“…Immunoglobulin gamma (IgG) is a protein representing approximately 75% of serum immunoglobulins in humans. Recent evidence demonstrates that the number of fungal, bacterial or opportunistic infections is increased in LTx recipients with severe hypogammaglobulinemia (<4 g/L) . IgG levels were also lower in those patients with chronic rejection and in those who subsequently developed chronic rejection compared with patients who were free of chronic rejection, which corresponds with an increased incidence of chronic rejection .…”

Section: Introductionmentioning

confidence: 99%

“…Recent evidence demonstrates that the number of fungal, bacterial or opportunistic infections is increased in LTx recipients with severe hypogammaglobulinemia (<4 g/L) . IgG levels were also lower in those patients with chronic rejection and in those who subsequently developed chronic rejection compared with patients who were free of chronic rejection, which corresponds with an increased incidence of chronic rejection . Severe hypogammaglobulinemia (<4 g/L) was associated with a worse 1‐year survival rate after LTx , possibly caused by an increased number of respiratory infections .…”

Section: Introductionmentioning

confidence: 99%

Genetic Variation in Immunoglobulin G Receptor Affects Survival After Lung Transplantation

Ruttens

Verleden

Goeminne

et al. 2014

American Journal of Transplantation

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Chronic rejection remains the most important complication after lung transplantation (LTx). There is mounting evidence that both rheumatoid arthritis and chronic rejection share similar inflammatory mechanisms. As genetic variants in the FCGR2A gene that encodes the immunoglobulin gamma receptor (IgGR) have been identified in rheumatoid arthritis, we investigated the relationship between a genetic variant in the IgGR gene and chronic rejection and mortality after LTx. Recipient DNA from blood or explant lung tissue of 418 LTx recipients was evaluated for the IgGR (rs12746613) polymorphism. Multivariate analysis was carried out, correcting for several co‐variants. In total, 216 patients had the CC‐genotype (52%), 137 had the CT‐genotype (33%) and 65 had the TT‐genotype (15%). Univariate analysis demonstrated higher mortality in the TT‐genotype compared with both other genotypes (p < 0.0001). Multivariate analysis showed that the TT‐genotype had worse survival compared with the CC‐genotype (hazard ratio [HR] = 2.26, p = 0.0002) but no significance was observed in the CT‐genotype (HR = 1.32, p = 0.18). No difference was seen for chronic rejection. The TT‐genotype demonstrated more respiratory infections (total, p = 0.037; per patient, p = 0.0022) compared with the other genotypes. A genetic variant in the IgGR is associated with higher mortality and more respiratory infections, although not with increased prevalence of chronic rejection, after LTx.

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Bronchiolitis obliterans syndrome, hypogammaglobulinemia, and infectious complications of lung transplantation

Cited by 30 publications

References 20 publications

Clinical features and outcomes of influenza infections in lung transplant recipients: a single‐season cohort study

Clinical features and outcomes of influenza infections in lung transplant recipients: a single‐season cohort study

Intravenous Immunoglobulin for Hypogammaglobulinemia after Lung Transplantation: A Randomized Crossover Trial

Genetic Variation in Immunoglobulin G Receptor Affects Survival After Lung Transplantation

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