Restoration of humoral immunity after intravenous immunoglobulin replacement therapy in heart recipients with post‐transplant antibody deficiency and severe infections

Abstract

IgG hypogammaglobulinemia is a risk factor for infection in heart recipients. We assessed reconstitution of humoral immunity after non-specific intravenous immunoglobulin (IVIg) replacement therapy administered to treat secondary IgG hypogammaglobulinemia in heart recipients with severe infections. The study population comprised 55 heart recipients who were administered IVIg (IVIg group) and 55 heart recipients with no severe infectious complications (control group). An event was defined as a severe infection requiring intravenous drug therapy during the first year after transplantation. The IVIg protocol comprised non-specific 5% pasteurized IVIg at a dose of 300-400 mg/kg/months. IgG titers were lower in the IVIg group than in controls at seven d (577 vs. 778 mg/dL, p < 0.001) and at one month (553 vs. 684, p = 0.003). After IVIg therapy, IgG concentrations were similar in both groups at three months (681 vs. 737, p = 0.25) and at six months (736 vs. 769, p = 0.46). At three months, the IVIg group had higher levels of antitetanus toxoid and anti-HBs (ELISA, 2.07 ± 2.11 vs. 0.60 ± 1.24 mg/dL [p = 0.003] and 42 ± 40 vs. 11 ± 31 IU/mL [p = 0.005], respectively) than controls. The mean number of infectious complications was significantly lower after IVIG therapy in the IVIG group. IVIg was associated with restoration of humoral immunity in heart recipients with post-transplant IgG hypogammaglobulinemia and severe infections.

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

“…Two studies published by Carbone et al . found no impact of IVIg administration on rejection rate . However, the studies published by Yamani demonstrated a significant reduction in the occurrence of grade 2 and 3 rejection , and these results were supported by the results from Nathan et al .…”

Antibody replacement therapy in primary antibody deficiencies and iatrogenic hypogammaglobulinemia

“…After IVIG therapy, humoral immune status in these patients was comparable with 55 non-hypogammaglobulinemic controls. Furthermore, the mean number of infections in the 6 months after IVIG therapy was significantly lower than that before IVIG therapy [82]. A double-blinded randomized controlled crossover trial in which 11 lung transplant recipients with hypogammaglobulinemia (defined as IgG <5 g/l) received IVIG and placebo for 3 months each did not find a reduced risk of bacterial infections under IVIG [83].…”

“…Almost all available reports describe the use of IVIG therapy, and data on the use of SCIG for IHG are virtually absent. Adverse effects of antibody replacement therapy are not discussed in most reports, but in three reports on post-solid organ transplantation hypogammaglobulinemic patients (combined n = 79, of whom 67 received ‡3 IVIG infusions), no moderate or severe adverse reactions were reported [81][82][83]. Discontinuation of antibody replacement therapy due to adverse effects is not mentioned in any of the reports.…”

Clinical outcomes of polyvalent immunoglobulin use in solid organ transplant recipients: A systematic review and meta‐analysis – Part II: Non‐kidney transplant

“…Pooled analysis of four studies revealed a reduced mortality in the IVIG (n = 167) group when compared to the control (n = 288) group(Figure 2; OR 0.34, 95% CI 0.17-0.69, I 2 = 0%, and Chi 2 = 2.20). Both studies did not find significant difference in mean number of rejection episodes between the IVIG treatment and control groups (0.86 vs 0.65, respectively; P = 0.33, 21 and 0.32 ± 0.60 vs 0.26 ± 0.57, respectively; P = 0.69) 23. Two of the six studies reported graft rejection outcome, but the reported data could not be pooled for meta-analysis 21,23.…”

“…Two of the six studies reported graft rejection outcome, but the reported data could not be pooled for meta-analysis 21,23. 21,23-25 Unlike the other studies, Carbone et al 33 2018 used IVIG as a secondaryprophylaxis; nevertheless, a reduced mortality was also observed in the IVIG group (P = 0.006).…”