title: Liver transplantation reverses hypergammaglobulinemia in patients with chronic hepatic failure.
abstract: BACKGROUND
  Sparse data are available about the effect of therapy methods on antibody levels in patients with liver failure. The aim of this study was to determine serum immunoglobulin concentrations in patients with chronic hepatic failure (CHF), acute- (ALF), or acute-on-chronic liver failure (ACLF) and to evaluate the impact of MARS treatment or liver transplantation (LT) on antibody levels.
  
  
  METHODS
  We followed ten patients with ALF, twelve with ACLF and 18 with CHF. Eight patients with ALF and seven with ACLF underwent MARS therapy, whereas the rest received LT. 13 healthy volunteers served as controls. Serum antibody concentrations were measured using ELISA-technique.
  
  
  RESULTS
  Median serum levels of IgA, IgG and IgM were significantly increased in patients with CHF compared to ALF or controls (P<0.02, P<0.01, and P<0.01). IgM and IgG concentrations were also significantly elevated in patients with CHF compared to ACLF (IgM, 3.7 vs. 1 g/L, P<0.001; IgG, 8.7 vs. 3.1 g/L, P=0.004). Immediately after LT a significant decrease of IgA (6.9 vs. 3.1 g/L, P=0.004), IgG (8.7 vs. 5.1 g/L, P=0.02) and IgM (3.7 vs. 1.8 g/L, P=0.001) was detected in patients with CHF and antibody levels further decreased the days after LT reaching levels comparable to healthy individuals. MARS treatment had no apparent effect on the immunoglobulin profile in patients with ALF or ACLF.
  
  
  CONCLUSIONS
  We provide evidence that LT reverses hypergammaglobulinemia in patients suffering from CHF within one day, which could be explained to a reconstituted hepatic antibody clearance, whereas MARS treatment has no immediate effect on immunoglobulin levels.
authors.affiliation: Department of Anesthesiology, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria ; Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University of Vienna, Vienna, Austria ; RAIC Laboratory 13C1, Medical University of Vienna, Vienna, Austria.
authors.forename: Diana
authors.initials: D
authors.lastname: Lebherz-Eichinger
authors.affiliation: Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Remy
authors.initials: R
authors.lastname: Schwarzer
authors.affiliation: Department of Anesthesiology, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria ; RAIC Laboratory 13C1, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Motal
authors.affiliation: Department of Anesthesiology, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria ; RAIC Laboratory 13C1, Medical University of Vienna, Vienna, Austria.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Klaus
authors.affiliation: Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University of Vienna, Vienna, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mangold
authors.affiliation: Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University of Vienna, Vienna, Austria ; Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Hendrik J
authors.initials: HJ
authors.lastname: Ankersmit
authors.affiliation: Department of Transplant Surgery, Medical University Vienna, Vienna, Austria.
authors.forename: Gabriela A
authors.initials: GA
authors.lastname: Berlakovich
authors.affiliation: Department of Anesthesiology, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria ; RAIC Laboratory 13C1, Medical University of Vienna, Vienna, Austria.
authors.forename: Claus G
authors.initials: CG
authors.lastname: Krenn
authors.affiliation: Department of Anesthesiology, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria ; RAIC Laboratory 13C1, Medical University of Vienna, Vienna, Austria.
authors.forename: Georg A
authors.initials: GA
authors.lastname: Roth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058625:End Stage Liver Disease / Q000097:blood / Q000150:complications / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006942:Hypergammaglobulinemia / Q000097:blood / Q000150:complications / Q000601:surgery; D007136:Immunoglobulins; D017114:Liver Failure, Acute / Q000097:blood / Q000150:complications / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged
chemical_list: D007136:Immunoglobulins
keywords: antibodies; artificial liver support system, molecular adsorbent recirculating system; immunoglobulins; liver failure; liver transplantation