The impact of hypogammaglobulinemia on infection outcome in patients undergoing ventricular assist device implantation.
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.
Yamani
Mohamad H
MH
Department of Cardiovascular Medicine, Kaufman Center for Heart Failure, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. yamanim@ccf.org
Chuang
Hsuan-Hung
HH
Ozduran
Volkan
V
Avery
Robin K
RK
Mawhorter
Steven D
SD
Cook
Daniel J
DJ
Zilka
Cathy
C
Zeroske
Kimberly
K
Buda
Tiffany
T
Hobbs
Robert E
RE
Taylor
David O
DO
Smedira
Nicholas G
NG
Starling
Randall C
RC
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