IgG monitoring to identify the risk for development of infection in heart transplant recipients

Abstract

Infectious complication represents a significant source of morbidity and mortality in heart transplant recipients. To assess humoral immunity markers that can predict the development of infection, 38 consecutive recipients of heart transplants performed at a single center were prospectively studied. Induction therapy included daclizumab. Immunoglobulin (IgG, IgA, IgM) and complement factors (C3, C4, and factor B) were performed by nephelometry in peripheral blood samples obtained before transplantation, and 7 days and 1 month after transplantation. During a mean follow-up of 16.9 months, 13 patients had at least one episode of infection (34.2%). Eight of these were cytomegalovirus (CMV) infections treated with intravenous ganciclovir, 2 were bacterial pneumonia, 1 patient had bacterial septicemia, 1 patient had urinary tract infection, and 1 patient had pulmonary nocardiosis. No significant association was found between infection and age, sex, immunosuppression, CMV serostatus of donor and recipient, or treated rejection episodes. Pre-transplant IgG (below median value=1140 mg/dL; relative risk [RR] 3.69; 95% confidence interval [CI] 1.01-13.54; P=0.04) and post-transplant IgG levels at day 7 (below median value=679 mg/dL; RR 11.21; CI 1.04-89.48; P=0.022) were associated with an increase in the risk for developing infections. Early monitoring of immunoglobulin levels might help to identify the risk for developing infection in heart transplantation.

Risk factors for cytomegalovirus reactivation after liver transplantation: Can pre‐transplant cytomegalovirus antibody titers predict outcome?

“…A small previous study suggested that a low pre-transplant CMV antibody titer in heart transplant recipients was related to the development of a CMV infection after transplant. [6][7][8] This conforms with the general observation that diminished overall humoral immunity, as indicated by a low IgG level (hypogammaglobulinemia) either before or after transplant, has been shown to increase the risk of CMV infection in SOT recipients. 7,16 Therefore, lower CMVspecific humoral immunity appears to predispose patients to a higher risk of posttransplant CMV infection.…”

“…[6][7][8] This conforms with the general observation that diminished overall humoral immunity, as indicated by a low IgG level (hypogammaglobulinemia) either before or after transplant, has been shown to increase the risk of CMV infection in SOT recipients. 7,16 Therefore, lower CMVspecific humoral immunity appears to predispose patients to a higher risk of posttransplant CMV infection. Anecdotally, CMV-Ig is being used as an adjunctive treatment for severe cases of CMV disease, especially pneumonitis and recurrent CMV disease, and for recipients with severe hypogammaglobulinemia.…”

“…A few studies reported that heart transplant recipients with CMV infection had lower CMV antibody titer than those without CMV infection. [6][7][8] More recently, studies in kidney and lung transplant recipients found that a lower pre-transplant cellular immune response, which is determined by interferon-g secretion by CMV-specific CD81 T cells, was correlated with a higher risk of CMV disease after transplantation. 9,10 However, these were limited by a small sample size, a nonhomogeneous population, and the use of antiviral prophylaxis, which confounded the outcome.…”

Monitoring of Immunoglobulin Levels Identifies Kidney Transplant Recipients at High Risk of Infection

“…Patients were enrolled at the time of transplantation and followed clinically for at least 1 year, unless they died before. We conventionally divided the posttransplant follow-up period in three intervals: early (first month), intermediate (months [1][2][3][4][5][6] and late (>6 months). Serum samples were collected just before transplantation (T 0 ) and at month 1 (T 1 ) and 6 (T 6 ).…”

“…All of them had immune assessment performed at T 0 . Samples at T 1 were available in 200 patients (88.9% of those surviving beyond the first month), whereas samples at T 6 were available in 153 (73.9% of surviving receptors with a functional graft beyond the first 6 months). There were no significant differences with regard to posttransplant infection or outcome between patients with immune assessment at T 1 and T 6 , and those from whom no specimens could be obtained, except for the higher incidence of delayed graft function among the latter (data not shown).…”