title: The impact of hypogammaglobulinemia on infection outcome in patients undergoing ventricular assist device implantation.
abstract: BACKGROUND
  Infection is a major comorbidity after ventricular assist device (VAD) placement. Defects in cellular immunity have been reported after VAD placement. However, to our knowledge, quantitative immunoglobulin G (IgG) level determination and the impact of hypogammaglobulinemia (HGG) on infections after VAD implantation have not been evaluated before.
  
  
  METHODS
  A total of 76 patients (mean age, 53 years) underwent VAD implantation as a bridge to transplantation and had IgG levels determined as a baseline before transplantation. Patients were divided into 2 groups according to IgG level: Control Group (n = 56, IgG > or = 700 mg/dl) and HGG Group (n = 20, IgG < 700 mg/dl). Infection outcome during the VAD course and after transplantation was analyzed in relation to the IgG level.
  
  
  RESULTS
  Baseline characteristics were similar in both groups. The incidence of bacteremia (14/20 [70%] vs 18/56 [32%], p = 0.0032) and major infection (19/20 [95%] vs 31/56 [56%], p = 0.0009) were significantly increased in the HGG Group compared with the Control Group. After transplantation, the episodes of rejection were similar in both groups and survival was similar. The HGG Group experienced more cytomegalovirus infections compared with the Control Group (9/20 [45%] vs 9/56 [16%], p = 0.009).
  
  
  CONCLUSIONS
  VAD patients with HGG are at increased risk of infections. After transplantation, these patients also experience increased cytomegalovirus infections. A randomized preemptive IgG replacement trial may be warranted in the future to determine if this intervention will alleviate the risk of infection.
authors.affiliation: Department of Cardiovascular Medicine, Kaufman Center for Heart Failure, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. yamanim@ccf.org
authors.forename: Mohamad H
authors.initials: MH
authors.lastname: Yamani
authors.forename: Hsuan-Hung
authors.initials: HH
authors.lastname: Chuang
authors.forename: Volkan
authors.initials: V
authors.lastname: Ozduran
authors.forename: Robin K
authors.initials: RK
authors.lastname: Avery
authors.forename: Steven D
authors.initials: SD
authors.lastname: Mawhorter
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Cook
authors.forename: Cathy
authors.initials: C
authors.lastname: Zilka
authors.forename: Kimberly
authors.initials: K
authors.lastname: Zeroske
authors.forename: Tiffany
authors.initials: T
authors.lastname: Buda
authors.forename: Robert E
authors.initials: RE
authors.lastname: Hobbs
authors.forename: David O
authors.initials: DO
authors.lastname: Taylor
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Smedira
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
mesh_terms: D000328:Adult; D000361:Agammaglobulinemia / Q000150:complications*; D001424:Bacterial Infections / Q000453:epidemiology* / Q000209:etiology*; D016022:Case-Control Studies; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000209:etiology*; D004198:Disease Susceptibility; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D016019:Survival Analysis; D014766:Viremia / Q000453:epidemiology / Q000209:etiology