title: Effect of hypogammaglobulinemia on the incidence of community-acquired respiratory viral infections after lung transplantation.
abstract: BACKGROUND
  Hypogammaglobulinemia (HGG) has been associated with an increased risk of infectious complications in lung transplant recipients, but its effect specifically on community-acquired respiratory viruses (CARVs) remains unknown. This study aimed to determine if lung transplant recipients with HGG are at an increased risk of developing CARV infection. Secondary endpoints included the effect of HGG on lung function, incidence of rejection, and mortality.
  
  
  METHODS
  A retrospective review of all lung transplant recipients from 2008 to 2011 was performed. Patients were stratified as either having HGG after transplantation or having normal IgG titers according to their nadir IgG level. HGG was defined a serum IgG level of <700 mg/dL. CARVs included human metapneumovirus, influenza A/B, respiratory syncytial virus A/B, parainfluenza 1/2/3, rhinovirus, and adenovirus isolated from bronchoalveolar lavage/wash, sputum, or nasal swab.
  
  
  RESULTS
  The cohort consisted of 263 patients with a mean follow-up time of 612 ± 356 days. The incidence of CARV infection was 27% in patients with normal IgG titers and 23.4% in patients with HGG (P = .62). No difference in rejection, mortality, or lung function was found between the groups. As expected, patients who ever had a CARV infection had a significantly lower 1-second forced expiratory volume % reference on their most recent spirometry than those who had not had a CARV infection (81.6% vs 86.9%; P = .027).
  
  
  CONCLUSIONS
  Although CARV infection has been shown to affect lung graft function, these data suggests that HGG is not associated with the incidence of CARV infection.
authors.affiliation: Department of Pharmacy, The Methodist Hospital, Houston, Texas, USA. bcnoell@gmail.com
authors.forename: B C
authors.initials: BC
authors.lastname: Noell
authors.forename: K L
authors.initials: KL
authors.lastname: Dawson
authors.forename: H
authors.initials: H
authors.lastname: Seethamraju
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D017074:Common Variable Immunodeficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D005260:Female; D005541:Forced Expiratory Volume; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000503:physiopathology / Q000821:virology; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014777:Virus Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000821:virology
chemical_list: D015415:Biomarkers; D007074:Immunoglobulin G