Intravenous immunoglobulin in heart transplant recipients with mild to moderate hypogammaglobulinemia and infection

Hoang, Johnny; Krisl, Jill C.; Moaddab, Mozhgon; Nguyen, Duc T.; Graviss, Edward A.; Hussain, Imad; Kassi, Mahwash; Yousefzai, Rayan; Trachtenberg, Barry; Bhimaraj, Arvind; Guha, Ashrith

doi:10.1111/ctr.14571

Cited by 3 publications

(5 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The stabilized weights take into account the probabilities of having HGG and at While this study identified HGG as a significant risk factor for infection in kidney transplant recipients, the role of IVIG replacement in mitigating this risk remains controversial. A small number of retrospective studies on the use of IVIG treatment in heart and lung transplant recipients with documented HGG have shown a reduced re-infection rate or mortality among those treated (21,22). IVIG replacement has demonstrated potential in preventing specific viral infections in a recent publication on the clinical trial on using IVIG vs. immunosuppressive reduction to treat BK viremia post-kidney transplantation.…”

Section: Discussionmentioning

confidence: 99%

The time-dependent changes in serum immunoglobulin after kidney transplantation and its association with infection

Jo,

Min,

et al. 2024

Front. Immunol.

View full text Add to dashboard Cite

IntroductionKidney transplant recipients often experience significant alterations in their immune system, which can lead to increased susceptibility to infections. This study aimed to analyze time-dependent changes in serum immunoglobulin and complement levels and determine the risk factors associated with infection.MethodsA retrospective analysis of serum samples from 192 kidney transplant recipients who received transplantations between August 2016 and December 2019 was conducted. The serum samples were obtained at preoperative baseline (T0), postoperative 2 weeks (T1), 3 months (T2), and 1 year (T3). The levels of serum C3, C4, IgG, IgA, and IgM were measured to evaluate immune status over time.ResultsThe analysis revealed significant decreases in IgG and IgA levels at T1. This period was associated with the highest occurrence of hypogammaglobulinemia (HGG) and hypocomplementemia (HCC), as well as an increased incidence of severe infection requiring hospitalization and graft-related viral infections. Using a time-dependent Cox proportional hazards model adjusted for time-varying confounders, HGG was significantly associated with an increased risk of infection requiring hospitalization (HR, 1.895; 95% CI: 1.871–1.920, P-value<0.001) and graft-related viral infection (HR, 1.152; 95% CI: 1.144–1.160, P-value<0.001).DiscussionThe findings suggest that monitoring serum immunoglobulin levels post-transplant provides valuable insights into the degree of immunosuppression. Hypogammaglobulinemia during the early post-transplant period emerges as a critical risk factor for infection, indicating that serum immunoglobulins could serve as feasible biomarkers for assessing infection risk in kidney transplant recipients.

show abstract

Section: Discussionmentioning

confidence: 99%

The time-dependent changes in serum immunoglobulin after kidney transplantation and its association with infection

Jo,

Min,

et al. 2024

Front. Immunol.

View full text Add to dashboard Cite

show abstract

“…There are no studies to date that specifically evaluate the efficacy of IVIG for HT rejection. It is most often used for AMR but may also be considered for a transplant recipient found to be severely immunodeficient (low immune globulin G level of <400 mg/dL) 50 . Premedication for IVIG infusion is not required but is common practice using acetaminophen and diphenhydramine.…”

Section: Desensitization Methods: Pre‐ or Post‐transplantationmentioning

confidence: 99%

“…It is most often used for AMR but may also be considered for a transplant recipient found to be severely immunodeficient (low immune globulin G level of <400 mg/dL). 50 Premedication for IVIG infusion is not required but is common practice using acetaminophen and diphenhydramine. HT recipients should avoid nonsteroidal anti-inflammatory drugs for premedication given the increased risk for acute renal failure in the setting of interaction with CNI affecting the renal vasculature.…”

Section: Intravenous Immunoglobulin Gmentioning

confidence: 99%

Pharmacotherapy in the heart transplant recipient: A primer for nurse clinicians and pharmacists

Fraser,

Page,

Chow

et al. 2024

Clinical Transplantation

View full text Add to dashboard Cite

Heart transplantation (HT) is the definitive treatment for eligible patients with end‐stage heart disease. A major complication of HT is allograft rejection which can lead to graft dysfunction and death. The guiding principle of chronic immunosuppression therapy is to prevent rejection of the transplanted organ while avoiding oversuppression of the immune system, which can cause opportunistic infections and malignancy. The purpose of this review is to describe immunosuppressive management of the HT recipient—including agent‐specific pharmacology and pharmacokinetics, outcomes data, adverse effects, clinical considerations, and recent guideline updates. We will also provide recommendations for medical prophylaxis of immunosuppressed patients based on the most recent clinical guidelines. Additionally, we highlight the importance of medical therapy adherence and the effect of social determinants of health on the long‐term management of HT. HT recipients are a complex and high‐risk population. The objective of this review is to describe basic pharmacotherapy in HT and implications for nurses and pharmacists.

show abstract

“…IVIg has been extensively used to prevent microbial and fungal infections and to reduce inflammation after transplantation [ 35 , 36 , 37 , 38 , 39 ] and in other inflammatory and autoimmune diseases [ 40 , 41 , 42 , 43 ]. IVIg is often administered to lower the level of anti-HLA Abs in end-stage organ disease patients and transplant recipients [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]. These findings lead Kaveri and his team [ 55 ] to propose a role for IVIg in immune homeostasis.…”

Section: The Diversity Of Hla-i Antibodiesmentioning

confidence: 99%

“…Additionally, IVIg modulates B-lineage cell antibody production. The use of IVIg for allograft recipients was approved by the US Food and Drug Administration (FDA) to reduce anti-HLA antibody levels prior to transplantation and to reverse humoral rejection [ 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ].…”

Section: The Immunoregulatory Potential Of Anti-hla-i Mabs Unravels T...mentioning

confidence: 99%

Role of HLA-I Structural Variants and the Polyreactive Antibodies They Generate in Immune Homeostasis

et al. 2022

View full text Add to dashboard Cite

Cell-surface HLA-I molecules consisting of β2-microglobulin (β2m) associated heavy chains (HCs), referred to as Face-1, primarily present peptides to CD8+ T-cells. HCs consist of three α-domains, with selected amino acid sequences shared by all alleles of all six isoforms. The cell-surface HLA undergoes changes upon activation by pathological conditions with the expression of β2m-free HCs (Face-2) resulting in exposure of β2m-masked sequences shared by almost all alleles and the generation of HLA-polyreactive antibodies (Abs) against them. Face-2 may homodimerize or heterodimerize with the same (Face-3) or different alleles (Face-4) preventing exposure of shared epitopes. Non-allo immunized males naturally carry HLA-polyreactive Abs. The therapeutic intravenous immunoglobulin (IVIg) purified from plasma of thousands of donors contains HLA-polyreactive Abs, admixed with non-HLA Abs. Purified HLA-polyreactive monoclonal Abs (TFL-006/007) generated in mice after immunizing with Face-2 are documented to be immunoregulatory by suppressing or activating different human lymphocytes, much better than IVIg. Our objectives are (a) to elucidate the complexity of the HLA-I structural variants, and their Abs that bind to both shared and uncommon epitopes on different variants, and (b) to examine the roles of those Abs against HLA-variants in maintaining immune homeostasis. These may enable the development of personalized therapeutic strategies for various pathological conditions.

show abstract

Intravenous immunoglobulin in heart transplant recipients with mild to moderate hypogammaglobulinemia and infection

Cited by 3 publications

References 10 publications

The time-dependent changes in serum immunoglobulin after kidney transplantation and its association with infection

The time-dependent changes in serum immunoglobulin after kidney transplantation and its association with infection

Pharmacotherapy in the heart transplant recipient: A primer for nurse clinicians and pharmacists

Role of HLA-I Structural Variants and the Polyreactive Antibodies They Generate in Immune Homeostasis

Contact Info

Product

Resources

About