Impact of Immunoglobulin Therapy in Intestinal Transplant Recipients With Posttransplantation Hypogammaglobulinemia.
BACKGROUND
Severe hypogammaglobulinemia (HGG) (IgG <400 mg/dL) following intestinal transplantation is common. Although IgG replacement therapy is commonly used, clinical outcomes associated with increasing IgG levels to >400 mg/dL are not well described.


METHODS
Kaplan-Meier analysis was performed to estimate survival, the log-rank test to compare survival distributions between groups, and the Fisher exact test to determine the association between HGG and rejection.


RESULTS
A total of 23 intestinal transplant (IT) recipients with a median age of 2.3 years (range, 0.7-41 years) at the time of HGG diagnosis were included. The types of transplants were liver-small bowel (73.9%), liver-small bowel-kidney (8.7%), and small bowel only (17.4%). The 3-year survival after the diagnosis of HGG was 50.2% (95% confidence interval [CI] = 28.2%-68.7%). There was no difference in survival (P = .67) when patients were dichotomized based upon IgG level at last follow-up (IgG ≥400 mg/dL, n = 14; and IgG <400 mg/dL, n = 9). There was no also evidence of an association between survival and: total dose (P = .58), frequency (P = .11), and number of IgG doses administered (P = .8). There was no difference in survival between patients receiving (n = 12) or not receiving (n = 11) cytomegalovirus hyperimmunoglobulin (P = .10).


CONCLUSIONS
Improved survival rates were not found in our IT recipients with severe HGG with immunoglobulin therapy to IgG levels of ≥400 mg/dL, even when cytomegalovirus hyperimmunoglobulin was administered.
Pulmonary, Critical Care, Sleep and Allergy Division, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
J A
JA
Poole
Biostatistics Department, University of Nebraska Medical Center, Omaha, Nebraska.
F
F
Qiu
Transplant Infectious Diseases Program, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
A C
AC
Kalil
Transplant Surgery Division, University of Nebraska Medical Center, Omaha, Nebraska.
W
W
Grant
Transplant Surgery Division, University of Nebraska Medical Center, Omaha, Nebraska.
D F
DF
Mercer
Transplant Infectious Diseases Program, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska; Transplant Surgery Division, University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: dflorescu@unmc.edu.
D F
DF
Florescu
D000293:Adolescent; D000328:Adult; D000361:Agammaglobulinemia / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007116:Immunization, Passive; D007074:Immunoglobulin G / Q000097:blood / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007223:Infant; D007422:Intestines / Q000637:transplantation*; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
D007074:Immunoglobulin G; D007155:Immunologic Factors