title: Bronchiolitis obliterans syndrome, hypogammaglobulinemia, and infectious complications of lung transplantation.
abstract: BACKGROUND
  Because infection has been associated with the development of bronchiolitis obliterans syndrome (BOS), we hypothesized that post-transplant hypogammaglobulinemia would be associated with infection and BOS.
  
  
  METHODS
  Cross-sectional levels of serum immunoglobulins were measured on 2 occasions in our transplant cohort and models developed to explain serum immunoglobulin levels and BOS-free survival.
  
  
  RESULTS
  A total of 139 patients (median age, 46.6 years) were evaluated at 47 months (range, 15-74 months) after transplant, and 87 were re-evaluated at 72 months (40-107 months). Of this cohort, 44% were immunoglobulin (Ig) G deficient and levels remained stable across the study period, and 27% were IgA deficient and levels fell slightly over time (p = 0.003). Both immunoglobulin classes were lower in patients with a history of invasive fungal infection, whereas IgA levels were lower in patients with a history of community-acquired respiratory viral infection. Low IgG was independently associated with shorter BOS-free survival (hazard ratio, 0.79; 95% confidence interval, 0.71-0.88; p<0.001).
  
  
  CONCLUSIONS
  Serum immunoglobulin deficiency is common after lung transplantation and is associated with community-acquired respiratory viral infection, invasive fungal infection, and BOS.
authors.affiliation: School of Medicine, The University of Queensland, Queensland, Australia. daniel_chambers@health.qld.gov.au
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Chambers
authors.forename: Belinda
authors.initials: B
authors.lastname: Davies
authors.forename: Ann
authors.initials: A
authors.lastname: Mathews
authors.forename: Stephanie T
authors.initials: ST
authors.lastname: Yerkovich
authors.forename: Peter M
authors.initials: PM
authors.lastname: Hopkins
mesh_terms: D000361:Agammaglobulinemia / Q000453:epidemiology / Q000209:etiology*; D001989:Bronchiolitis Obliterans / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology / Q000209:etiology*; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013577:Syndrome