title: Hypogammaglobulinemia after heart transplantation: impact of pre-emptive use of immunoglobulin replacement (CytoGam) on infection and rejection outcomes.
abstract: Hypogammaglobulinemia (HGG) in solid organ transplant (SOT) patients confers an increased risk of opportunistic infections and poorer outcomes. Severe HGG (IgG < 350 mg/dL) after heart transplantation may follow intensification of immunosuppressive therapy and the resultant increased risk of opportunistic infections, particularly cytomegalovirus (CMV) disease. Evaluation of the effects of replacement therapy using intravenous immunoglobulin (CMV-IGIV, CytoGam) was conducted in cardiac transplant recipients and the data matched with a historical control group. Patients with severe HGG who received pre-emptive replacement therapy had significantly fewer opportunistic infections (P < 0.001) and episodes of rejection (grade > or = 3; P = 0.03 and grade > or = 2; P = 0.04) compared with the control group.
authors.affiliation: Departament of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA. yamanim@ccf.org
authors.forename: M H
authors.initials: MH
authors.lastname: Yamani
authors.forename: R
authors.initials: R
authors.lastname: Avery
authors.forename: S
authors.initials: S
authors.lastname: Mawhorter
authors.forename: J B
authors.initials: JB
authors.lastname: Young
authors.forename: A
authors.initials: A
authors.lastname: McNeill
authors.forename: D J
authors.initials: DJ
authors.lastname: Cook
authors.forename: N B
authors.initials: NB
authors.lastname: Ratiff
authors.forename: P
authors.initials: P
authors.lastname: McCarthy
authors.forename: R C
authors.initials: RC
authors.lastname: Starling
mesh_terms: D000328:Adult; D000361:Agammaglobulinemia / Q000188:drug therapy* / Q000209:etiology; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000276:immunology* / Q000517:prevention & control*; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D007136:Immunoglobulins / Q000627:therapeutic use*; D016756:Immunoglobulins, Intravenous; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; C045781:cytomegalovirus-specific hyperimmune globulin