Hypogammaglobulinemia following cardiac transplantation: A link between rejection and infection

Mohamad H. Yamani, Robin K. Avery, Steven D. Mawhorter, James B. Young, Norman B. Ratliff, Robert E. Hobbs, Patrick M. McCarthy, Nicholas G. Smedira, Marlene Goormastic, David Pelegrin, Randall C. Starling

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Background: Hypogammaglobulinemia (HGG) has been reported after solid organ transplantation and is noted to confer an increased risk of opportunistic infections. Objectives: In this study, we sought to assess the relationship between severe HGG to infection and acute cellular rejection following heart transplantation. Methods: Between February 1997 and January 1999, we retrospectively analyzed the clinical outcome of 111 consecutive heart transplant recipients who had immunoglobulin G (IgG) level monitoring at 3 and 6 months post-transplant and when clinically indicated. Results: Eighty-one percent of patients were males, mean age 54 ± 13 years, and the mean follow-up period was 13.8 ± 5.7 months. Patients had normal IgG levels prior to transplant (mean 1137 ± 353 mg/dl). Ten percent (11 of 111) of patients developed severe HGG (IgG < 350 mg/dl) post-transplant. The average time to the lowest IgG level was 196 ± 125 days. Patients with severe HGG were at increased risk of opportunistic infections compared to patients with IgG > 350 mg/dl (55% [6 of 11] vs 5% [5 of 100], odds ratio = 22.8, p < 0.001). Compared to patients with no rejection, patients who experienced three or more episodes of rejection had lower mean IgG (580 ± 309 vs 751 ± 325, p = 0.05), and increased incidence of severe HGG (33% [7 of 21] vs 2.8% [1 of 35], p = 0.001). The incidence of rejection episodes per patient at 1 year was higher in patients with severe HGG compared to patients with IgG >350 (2.82 ± 1.66 vs 1.36 ± 1.45 episodes/patient, p = 0.02). The use of parenteral steroid pulse therapy was associated with an increased risk of severe HGG (odds ratio = 15.28, p < 0.001). Conclusions: Severe HGG after cardiac transplantation may develop as a consequence of intensification of immunosuppressive therapy for rejection and hence, confers an increased risk of opportunistic infections. IgG level may be a useful marker for identifying patients at high risk.

Original languageEnglish (US)
Pages (from-to)425-430
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume20
Issue number4
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Agammaglobulinemia
Heart Transplantation
Immunoglobulin G
Infection
Opportunistic Infections
Odds Ratio
Transplants
Organ Transplantation
Immunosuppressive Agents
Steroids
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Yamani, M. H., Avery, R. K., Mawhorter, S. D., Young, J. B., Ratliff, N. B., Hobbs, R. E., ... Starling, R. C. (2001). Hypogammaglobulinemia following cardiac transplantation: A link between rejection and infection. Journal of Heart and Lung Transplantation, 20(4), 425-430. https://doi.org/10.1016/S1053-2498(00)00331-4

Hypogammaglobulinemia following cardiac transplantation : A link between rejection and infection. / Yamani, Mohamad H.; Avery, Robin K.; Mawhorter, Steven D.; Young, James B.; Ratliff, Norman B.; Hobbs, Robert E.; McCarthy, Patrick M.; Smedira, Nicholas G.; Goormastic, Marlene; Pelegrin, David; Starling, Randall C.

In: Journal of Heart and Lung Transplantation, Vol. 20, No. 4, 2001, p. 425-430.

Research output: Contribution to journalArticle

Yamani, MH, Avery, RK, Mawhorter, SD, Young, JB, Ratliff, NB, Hobbs, RE, McCarthy, PM, Smedira, NG, Goormastic, M, Pelegrin, D & Starling, RC 2001, 'Hypogammaglobulinemia following cardiac transplantation: A link between rejection and infection', Journal of Heart and Lung Transplantation, vol. 20, no. 4, pp. 425-430. https://doi.org/10.1016/S1053-2498(00)00331-4
Yamani, Mohamad H. ; Avery, Robin K. ; Mawhorter, Steven D. ; Young, James B. ; Ratliff, Norman B. ; Hobbs, Robert E. ; McCarthy, Patrick M. ; Smedira, Nicholas G. ; Goormastic, Marlene ; Pelegrin, David ; Starling, Randall C. / Hypogammaglobulinemia following cardiac transplantation : A link between rejection and infection. In: Journal of Heart and Lung Transplantation. 2001 ; Vol. 20, No. 4. pp. 425-430.
@article{b89c730e1c3142b69fe36f9f5776349a,
title = "Hypogammaglobulinemia following cardiac transplantation: A link between rejection and infection",
abstract = "Background: Hypogammaglobulinemia (HGG) has been reported after solid organ transplantation and is noted to confer an increased risk of opportunistic infections. Objectives: In this study, we sought to assess the relationship between severe HGG to infection and acute cellular rejection following heart transplantation. Methods: Between February 1997 and January 1999, we retrospectively analyzed the clinical outcome of 111 consecutive heart transplant recipients who had immunoglobulin G (IgG) level monitoring at 3 and 6 months post-transplant and when clinically indicated. Results: Eighty-one percent of patients were males, mean age 54 ± 13 years, and the mean follow-up period was 13.8 ± 5.7 months. Patients had normal IgG levels prior to transplant (mean 1137 ± 353 mg/dl). Ten percent (11 of 111) of patients developed severe HGG (IgG < 350 mg/dl) post-transplant. The average time to the lowest IgG level was 196 ± 125 days. Patients with severe HGG were at increased risk of opportunistic infections compared to patients with IgG > 350 mg/dl (55{\%} [6 of 11] vs 5{\%} [5 of 100], odds ratio = 22.8, p < 0.001). Compared to patients with no rejection, patients who experienced three or more episodes of rejection had lower mean IgG (580 ± 309 vs 751 ± 325, p = 0.05), and increased incidence of severe HGG (33{\%} [7 of 21] vs 2.8{\%} [1 of 35], p = 0.001). The incidence of rejection episodes per patient at 1 year was higher in patients with severe HGG compared to patients with IgG >350 (2.82 ± 1.66 vs 1.36 ± 1.45 episodes/patient, p = 0.02). The use of parenteral steroid pulse therapy was associated with an increased risk of severe HGG (odds ratio = 15.28, p < 0.001). Conclusions: Severe HGG after cardiac transplantation may develop as a consequence of intensification of immunosuppressive therapy for rejection and hence, confers an increased risk of opportunistic infections. IgG level may be a useful marker for identifying patients at high risk.",
author = "Yamani, {Mohamad H.} and Avery, {Robin K.} and Mawhorter, {Steven D.} and Young, {James B.} and Ratliff, {Norman B.} and Hobbs, {Robert E.} and McCarthy, {Patrick M.} and Smedira, {Nicholas G.} and Marlene Goormastic and David Pelegrin and Starling, {Randall C.}",
year = "2001",
doi = "10.1016/S1053-2498(00)00331-4",
language = "English (US)",
volume = "20",
pages = "425--430",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "4",

}

TY - JOUR

T1 - Hypogammaglobulinemia following cardiac transplantation

T2 - A link between rejection and infection

AU - Yamani, Mohamad H.

AU - Avery, Robin K.

AU - Mawhorter, Steven D.

AU - Young, James B.

AU - Ratliff, Norman B.

AU - Hobbs, Robert E.

AU - McCarthy, Patrick M.

AU - Smedira, Nicholas G.

AU - Goormastic, Marlene

AU - Pelegrin, David

AU - Starling, Randall C.

PY - 2001

Y1 - 2001

N2 - Background: Hypogammaglobulinemia (HGG) has been reported after solid organ transplantation and is noted to confer an increased risk of opportunistic infections. Objectives: In this study, we sought to assess the relationship between severe HGG to infection and acute cellular rejection following heart transplantation. Methods: Between February 1997 and January 1999, we retrospectively analyzed the clinical outcome of 111 consecutive heart transplant recipients who had immunoglobulin G (IgG) level monitoring at 3 and 6 months post-transplant and when clinically indicated. Results: Eighty-one percent of patients were males, mean age 54 ± 13 years, and the mean follow-up period was 13.8 ± 5.7 months. Patients had normal IgG levels prior to transplant (mean 1137 ± 353 mg/dl). Ten percent (11 of 111) of patients developed severe HGG (IgG < 350 mg/dl) post-transplant. The average time to the lowest IgG level was 196 ± 125 days. Patients with severe HGG were at increased risk of opportunistic infections compared to patients with IgG > 350 mg/dl (55% [6 of 11] vs 5% [5 of 100], odds ratio = 22.8, p < 0.001). Compared to patients with no rejection, patients who experienced three or more episodes of rejection had lower mean IgG (580 ± 309 vs 751 ± 325, p = 0.05), and increased incidence of severe HGG (33% [7 of 21] vs 2.8% [1 of 35], p = 0.001). The incidence of rejection episodes per patient at 1 year was higher in patients with severe HGG compared to patients with IgG >350 (2.82 ± 1.66 vs 1.36 ± 1.45 episodes/patient, p = 0.02). The use of parenteral steroid pulse therapy was associated with an increased risk of severe HGG (odds ratio = 15.28, p < 0.001). Conclusions: Severe HGG after cardiac transplantation may develop as a consequence of intensification of immunosuppressive therapy for rejection and hence, confers an increased risk of opportunistic infections. IgG level may be a useful marker for identifying patients at high risk.

AB - Background: Hypogammaglobulinemia (HGG) has been reported after solid organ transplantation and is noted to confer an increased risk of opportunistic infections. Objectives: In this study, we sought to assess the relationship between severe HGG to infection and acute cellular rejection following heart transplantation. Methods: Between February 1997 and January 1999, we retrospectively analyzed the clinical outcome of 111 consecutive heart transplant recipients who had immunoglobulin G (IgG) level monitoring at 3 and 6 months post-transplant and when clinically indicated. Results: Eighty-one percent of patients were males, mean age 54 ± 13 years, and the mean follow-up period was 13.8 ± 5.7 months. Patients had normal IgG levels prior to transplant (mean 1137 ± 353 mg/dl). Ten percent (11 of 111) of patients developed severe HGG (IgG < 350 mg/dl) post-transplant. The average time to the lowest IgG level was 196 ± 125 days. Patients with severe HGG were at increased risk of opportunistic infections compared to patients with IgG > 350 mg/dl (55% [6 of 11] vs 5% [5 of 100], odds ratio = 22.8, p < 0.001). Compared to patients with no rejection, patients who experienced three or more episodes of rejection had lower mean IgG (580 ± 309 vs 751 ± 325, p = 0.05), and increased incidence of severe HGG (33% [7 of 21] vs 2.8% [1 of 35], p = 0.001). The incidence of rejection episodes per patient at 1 year was higher in patients with severe HGG compared to patients with IgG >350 (2.82 ± 1.66 vs 1.36 ± 1.45 episodes/patient, p = 0.02). The use of parenteral steroid pulse therapy was associated with an increased risk of severe HGG (odds ratio = 15.28, p < 0.001). Conclusions: Severe HGG after cardiac transplantation may develop as a consequence of intensification of immunosuppressive therapy for rejection and hence, confers an increased risk of opportunistic infections. IgG level may be a useful marker for identifying patients at high risk.

UR - http://www.scopus.com/inward/record.url?scp=0035047884&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035047884&partnerID=8YFLogxK

U2 - 10.1016/S1053-2498(00)00331-4

DO - 10.1016/S1053-2498(00)00331-4

M3 - Article

C2 - 11295580

AN - SCOPUS:0035047884

VL - 20

SP - 425

EP - 430

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 4

ER -