title: Does increasing immunoglobulin levels impact survival in solid organ transplant recipients with hypogammaglobulinemia?
abstract: BACKGROUND
  Severe hypogammaglobulinemia (IgG < 400 mg/dL) has adverse impact on mortality during the first year post-transplantation. The aim of the study was to determine whether increasing IgG levels to ≥400 mg/dL improved outcomes.
  
  
  METHODS
  Kaplan-Meier analyses were performed to estimate survival, log-rank test to compare survival distributions between groups, and Fisher's exact test to determine the association between hypogammaglobulinemia and rejection or graft loss.
  
  
  RESULTS
  Thirty-seven solid organ transplant (SOT) recipients were included. Hypogammaglobulinemia was diagnosed at median of 5.6 months (range: 0-291.8 months) post-transplantation. Types of transplants: liver-small bowel (17); liver-small bowel-kidney (2); liver (5); small bowel (4); liver-kidney (1); kidney/kidney-pancreas (3); heart (3); heart-kidney (1); and heart-lung (1). The three-yr survival after the diagnosis of hypogammaglobulinemia was 49.5% (95% CI: 32.2-64.6%). Patients were dichotomized based upon IgG level at last follow-up: IgG ≥ 400 mg/dL (23 patients) and IgG < 400 mg/dL (14 patients). There was no evidence of a difference in survival (p = 0.44), rejection rate (p = 0.44), and graft loss censored for death (p = 0.99) at one yr between these two groups. There was no difference in survival between patients receiving or not immunoglobulin (p = 0.99) or cytomegalovirus hyperimmunoglobulin (p = 0.14).
  
  
  CONCLUSIONS
  Severe hypogammaglobulinemia after SOT is associated with high mortality rates, but increasing IgG levels to ≥400 mg/dL did not seem to translate in better patient or graft survival in this cohort.
authors.affiliation: Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE, USA; Transplant Surgery Division, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Diana F
authors.initials: DF
authors.lastname: Florescu
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
authors.forename: Fang
authors.initials: F
authors.lastname: Qiu
authors.forename: Wendy
authors.initials: W
authors.lastname: Grant
authors.forename: Michael C
authors.initials: MC
authors.lastname: Morris
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Schmidt
authors.forename: Marius C
authors.initials: MC
authors.lastname: Florescu
authors.forename: Jill A
authors.initials: JA
authors.lastname: Poole
mesh_terms: D000361:Agammaglobulinemia / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000097:blood*; D006085:Graft Survival; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007155:Immunologic Factors / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D016377:Organ Transplantation / Q000401:mortality*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007074:Immunoglobulin G; D007155:Immunologic Factors
keywords: hypogammaglobulinemia; immunoglobulin; mortality; survival; transplantation