Incidence, Timing, and Significance of Early Hypogammaglobulinemia After Intestinal Transplantation

Abstract

Background Despite recent advances in intestinal transplantation (ITx), infection (INF) and acute cellular rejection (ACR) remain major causes of patient and graft loss. Studies in other solid-organ transplantations indicate that low levels of serum immunoglobulin G (IgG) negatively impact outcomes. To date, there have been no studies on IgG after ITx. Methods A retrospective review of an IgG measurement protocol in primary ITx recipients between 2007 and 2011 was undertaken. IgG levels were measured at the time of evaluation, transplantation, and at weekly intervals for 2 months. Hypogammaglobulinemia (HGG) was defined as IgG levels below the lower limit of the 95% confidence interval for age. Associations between HGG, INF, and ACR were tested, and the incidence and timing of INF and ACR were compared. Results Thirty-four patients were transplanted at a mean (SD) age of 12.4 (17.2) years. Most were Latino children with gastroschisis who received multivisceral grafts. Relative to pre-ITx levels, a statistically significant decrease in IgG levels was observed after ITx (PG0.05). Twenty patients (59%) developed HGG during the post-ITx period at a mean (SD) of 9.8 days. No significant associations were identified between HGG and INF or ACR. Conclusions This is the first study to describe serum IgG levels after ITx. A marked decrease in serum IgG levels was observed early on, in most patients. The etiology is potentially related to immunotherapy. HGG was not associated with INF or ACR, possibly related to the sample size and our practice of exogenous intravenous immunoglobulin replacement.

Clinical immune‐monitoring strategies for predicting infection risk in solid organ transplantation

“…Nevertheless, a recent meta-analysis reported that mild (serum immunoglobulin G (IgG) levels 400–700 mg dl −1 ) and severe (IgG <400 mg dl −1 ) HGG occur in as many as 39% and 15% of patients during the first year post-transplant, respectively. 11 The incidence and clinical implications of HGG have been assessed in kidney, 12, 13, 14, 15 liver, 16 lung, 17, 18, 19 heart 20 and intestinal 21 transplant recipients. The mechanisms leading to post-transplant HGG are not fully clarified and are likely multifactorial, including the decrease in CD4 + T-cell numbers and its subsequent impact on B-cell activation.…”

Solid organ transplantation: hypogammaglobulinaemia and infectious complications after solid organ transplantation

“…A recent publication from Farmer et al . indicates that the rate of HGG may be high in these patients (59%) . This study retrospectively evaluated 34 intestinal transplant recipients, with a mean age of 12·4 years (standard deviation 17·2), 76% of whom were paediatric patients and 62% were male .…”

“…Serum IgG fell quickly in the first week after transplantation, most probably as a result of hypercatabolic state and protein-losing enteropathy [4]. Following the first week, serum IgG levels did improve, but did not recover to pre-transplantation levels [4].…”

“…Subset analysis showed a much higher rate of HGG in heart (49%), lung (63%) and kidney (40%) transplant recipients compared with liver transplant recipients (16%) [1].No studies evaluating HGG after intestinal transplantation were included in the meta-analysis, and there are limited data available. A recent publication from Farmer et al indicates that the rate of HGG may be high in these patients (59%) [4]. This study retrospectively evaluated 34 intestinal transplant recipients, with a mean age of 12·4 years (standard deviation 17·2), 76% of whom were paediatric patients and 62% were male [4].…”

“…Serum IgG levels were measured at the time of evaluation, at the time of transplantation and at weekly intervals for 2 months posttransplant [4]. Serum IgG fell quickly in the first week after transplantation, most probably as a result of hypercatabolic state and protein-losing enteropathy [4]. Following the first week, serum IgG levels did improve, but did not recover to pre-transplantation levels [4].In our meta-analysis, we observed a 2·46-fold increased risk of overall infections in patients with severe HGG, compared with patients with serum IgG > 400 mg/dl (95% CI = 1·22-4·93; P = 0·01, two studies, 267 patients) and a 3·73-fold increased risk when compared with patients with normal levels of serum IgG (95% CI = 1·11-12·49; P = 0·03, two studies, 267 patients) [1].…”