The Outcomes of Lung Transplantation in Patients With Bronchiectasis and Antibody Deficiency

Nathan, James A.; Sharples, Linda D.; Exley, Andrew; Sivasothy, Pasupathy; Wallwork, J.

doi:10.1016/j.healun.2004.11.013

Cited by 22 publications

(25 citation statements)

References 22 publications

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“…243 The actuarial survival was comparable between the two groups. The 1 year survival was 81% in the bronchiectasis group and 80% in bronchiectasis-antibody deficiency recipients.…”

Section: Sectionmentioning

confidence: 87%

British Thoracic Society Guideline for bronchiectasis in adults

Hill

Sullivan

Chalmers

et al. 2018

Thorax

379

348

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“…243 The actuarial survival was comparable between the two groups. The 1 year survival was 81% in the bronchiectasis group and 80% in bronchiectasis-antibody deficiency recipients.…”

Section: Sectionmentioning

confidence: 87%

British Thoracic Society Guideline for bronchiectasis in adults

Hill

Sullivan

Chalmers

et al. 2018

Thorax

379

348

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“…In the study by Nathan et al [11], 5 out of a series of 37 patients with bronchiectasis had demonstrable antibody deficiency pre-transplantation (and only 1 of these had a pre-transplant diagnosis of CVID, which coincidentally was the same patient described by Yeatman and Hill et al, above). In the study of 22 patients by Bierne et al [10], 2 patients were identified with pretransplant hypogammaglobulinaemia, 1 patient with panhypogammaglobulinaemia and the other with an IgG 1 subclass deficiency.…”

Section: Discussionmentioning

confidence: 74%

“…While lung transplanted patients with isolated hypogammaglobulinaemia receiving immunoglobulin replacement may have a comparable survival to patients without antibody deficiency in some series [11], many solid organ transplanted CVID patients reported in the literature have had a complicated postoperative course. It is unclear whether the outcome after transplantation is a reflection of the varying phenotypes between patients with CVID [3].…”

Section: Discussionmentioning

confidence: 99%

“…There have been several published series reporting outcome after transplantation for non-cystic fibrosis bronchiectasis [10,11]; however, the reported experience of lung transplantation in patients with CVID in particular, remains small. In the study by Nathan et al [11], 5 out of a series of 37 patients with bronchiectasis had demonstrable antibody deficiency pre-transplantation (and only 1 of these had a pre-transplant diagnosis of CVID, which coincidentally was the same patient described by Yeatman and Hill et al, above).…”

Section: Discussionmentioning

confidence: 99%

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Common variable immune deficiency and lung transplantation

Burton

Milman

Andersen

et al. 2007

Scandinavian Journal of Infectious Diseases

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We report on a male patient with bronchiectasis secondary to common variable immune deficiency (CVID) receiving lung transplantation. The patient had been diagnosed with CVID many y prior to right-sided single lung transplantation and was receiving appropriate immunoglobulin substitution therapy. He received antithymocyte globulin induction and maintenance triple therapy with cyclosporine, azathioprine and prednisolone. The early post-operative course was complicated by the development of severe acute cellular rejection and organizing pneumonia. Despite immunoglobulin replacement and antifungal prophylaxis and treatment, Aspergillus fumigatus was repeatedly cultured from bronchoalveolar lavage fluid, 18 months after transplantation. The patient died following a protracted period of repeated hospital admissions, 46 months after transplantation. A review of the literature suggests that many CVID patients appear to have had a complicated post-operative course after lung- and other solid-organ transplantation, and highlights the need for the establishment of international registries for transplanted patients with uncommon conditions.

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“…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 . . Although three of the studies reported on mortality , the event rates in these studies were very low, making it difficult to draw valid conclusions.…”

Section: Summary Of Key Characteristics Of Studies Investigating Treamentioning

confidence: 96%

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

Florescu

2014

Clin Exp Immunol

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Hypogammaglobulinaemia (HGG), defined as a serum immunoglobulin G (IgG) level < 700 mg/dl, is a known complication of solid organ transplantation (SOT), with a high prevalence reported following heart, lung and kidney transplantation [1,2]. HGG is associated with an increased risk of infection, which depends upon the degree of HGG, the type of allograft and the intensity of immunosuppression [1,2]. Although all agents used for maintenance immunosuppression have a direct effect on T cell function and an indirect effect on B cell function and lymphokine production, some immunosuppressive agents (e.g. mycophenolate mofetil) have a more potent inhibitor effect on B lymphocyte proliferation and antibody production and may result in more pronounced HGG [1,3]. HGG can occur following induction therapy, maintenance immunosuppressive regimens or treatment of rejection episodes [1]. Monitoring serum IgG levels before and after SOT has been proposed as a tool to predict clinical outcomes; however, the conclusions of the published studies have been limited by the relatively small sample size. Therefore, our group from the University of Nebraska carried out a meta-analysis to evaluate the prevalence of HGG after SOT and its impact on the rate of opportunistic infections during the first year posttransplantation [1]. This meta-analysis included 18 studies (1756 patients), with a mean age of 42 years [95% confidence interval (CI) = 30·9-53·1; Q-statistic = 8249·87; 15 studies, 1232 patients], 43% of whom were female (95% CI = 0·35-0·50; Q = 93·04; 14 studies, 1140 patients) [1]. HGG (serum IgG < 700 mg/dl) was found to be highly prevalent, occurring in 45% of transplant recipients in the first year post-transplantation (95% CI = 0·34-0·55; Q = 329·63; P < 0·0001; 16 studies, 1482 patients), while severe HGG (defined as serum IgG < 400 mg/dl) was less common, occurring in only 15% of transplant recipients (95% CI = 0·08-0·22; Q statistic = 210·09, P < 0·0001; eight studies, 669 patients) [1]. The heterogeneity of the studies included in the meta-analysis was high, most likely due to inherent differences in individual studies, such as the inclusion of both paediatric and adult studies, variation in study design and the inclusion of different allografts. 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 ...

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The Outcomes of Lung Transplantation in Patients With Bronchiectasis and Antibody Deficiency

Cited by 22 publications

References 22 publications

British Thoracic Society Guideline for bronchiectasis in adults

British Thoracic Society Guideline for bronchiectasis in adults

Common variable immune deficiency and lung transplantation

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

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