The impact of CytoGam on cardiac transplant recipients with moderate hypogammaglobulinemia: A randomized single-center study

Mohamad H. Yamani, Robin Avery, Steven D. Mawhorter, Ann McNeill, Daniel Cook, Norman B. Ratliff, David Pelegrin, Phyllis Colosimo, Karen Kiefer, Kristin Ludrosky, Robert Hobbs, David Taylor, Tiffany Buda, Michael Yeager, James B. Young, Nicholas Smedira, Randall C. Starling

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background: We have previously shown that the preemptive use of cytomegalovirus (CMV) immunoglobulin (Ig) replacement (CytoGam) decreases the incidence of opportunistic infections in cardiac transplant recipients with severe hypogammaglobulinemia. However, the impact of Ig replacement in moderately hypogammaglobulinemic patients is unknown. Methods: Periodic monitoring of the IgG levels was done in 300 heart transplant recipients. Moderate hypogammaglobulinemia (IgG, 350-500 mg/dl) developed in 56 patients (18.6%). Thirty-three patients declined randomization but agreed to have their IgG levels monitored. Twenty-three patients were randomized to placebo (n = 10) or CytoGam (n = 13) at 105 ± 63 days after transplantation. Results: The baseline characteristics were similar. A significant reduction in CMV infection was noted in the CytoGam Group compared with the Placebo Group (15.4% [2/13] vs 60% [6/10], p = .039). Among patients who declined randomization, CMV infection developed in 13 (39.4%) of 33, and 6 (46.1%) of the 13 progressed to severe hypogammaglobulinemia. A trend for reduction in the average episodes of <grade 2 rejection during the 6-month period after randomization was noted in the CytoGam group (0.4 ± 0.6 vs 1.4 ± 1.3, p = 0.065). Conclusions: The preemptive use of CytoGam decreases the incidence of CMV infection in patients with moderate hypogammaglobulinemia. A larger randomized study is needed to substantiate these results.

Original languageEnglish (US)
Pages (from-to)1766-1769
Number of pages4
JournalJournal of Heart and Lung Transplantation
Volume24
Issue number11
DOIs
StatePublished - Nov 2005
Externally publishedYes

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Agammaglobulinemia
Cytomegalovirus Infections
Random Allocation
Immunoglobulin G
Immunoglobulins
Placebos
Incidence
Opportunistic Infections
Cytomegalovirus
cytomegalovirus-specific hyperimmune globulin
Transplant Recipients
Transplantation

ASJC Scopus subject areas

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

Cite this

The impact of CytoGam on cardiac transplant recipients with moderate hypogammaglobulinemia : A randomized single-center study. / Yamani, Mohamad H.; Avery, Robin; Mawhorter, Steven D.; McNeill, Ann; Cook, Daniel; Ratliff, Norman B.; Pelegrin, David; Colosimo, Phyllis; Kiefer, Karen; Ludrosky, Kristin; Hobbs, Robert; Taylor, David; Buda, Tiffany; Yeager, Michael; Young, James B.; Smedira, Nicholas; Starling, Randall C.

In: Journal of Heart and Lung Transplantation, Vol. 24, No. 11, 11.2005, p. 1766-1769.

Research output: Contribution to journalArticle

Yamani, MH, Avery, R, Mawhorter, SD, McNeill, A, Cook, D, Ratliff, NB, Pelegrin, D, Colosimo, P, Kiefer, K, Ludrosky, K, Hobbs, R, Taylor, D, Buda, T, Yeager, M, Young, JB, Smedira, N & Starling, RC 2005, 'The impact of CytoGam on cardiac transplant recipients with moderate hypogammaglobulinemia: A randomized single-center study', Journal of Heart and Lung Transplantation, vol. 24, no. 11, pp. 1766-1769. https://doi.org/10.1016/j.healun.2004.11.016
Yamani, Mohamad H. ; Avery, Robin ; Mawhorter, Steven D. ; McNeill, Ann ; Cook, Daniel ; Ratliff, Norman B. ; Pelegrin, David ; Colosimo, Phyllis ; Kiefer, Karen ; Ludrosky, Kristin ; Hobbs, Robert ; Taylor, David ; Buda, Tiffany ; Yeager, Michael ; Young, James B. ; Smedira, Nicholas ; Starling, Randall C. / The impact of CytoGam on cardiac transplant recipients with moderate hypogammaglobulinemia : A randomized single-center study. In: Journal of Heart and Lung Transplantation. 2005 ; Vol. 24, No. 11. pp. 1766-1769.
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abstract = "Background: We have previously shown that the preemptive use of cytomegalovirus (CMV) immunoglobulin (Ig) replacement (CytoGam) decreases the incidence of opportunistic infections in cardiac transplant recipients with severe hypogammaglobulinemia. However, the impact of Ig replacement in moderately hypogammaglobulinemic patients is unknown. Methods: Periodic monitoring of the IgG levels was done in 300 heart transplant recipients. Moderate hypogammaglobulinemia (IgG, 350-500 mg/dl) developed in 56 patients (18.6{\%}). Thirty-three patients declined randomization but agreed to have their IgG levels monitored. Twenty-three patients were randomized to placebo (n = 10) or CytoGam (n = 13) at 105 ± 63 days after transplantation. Results: The baseline characteristics were similar. A significant reduction in CMV infection was noted in the CytoGam Group compared with the Placebo Group (15.4{\%} [2/13] vs 60{\%} [6/10], p = .039). Among patients who declined randomization, CMV infection developed in 13 (39.4{\%}) of 33, and 6 (46.1{\%}) of the 13 progressed to severe hypogammaglobulinemia. A trend for reduction in the average episodes of",
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AU - Avery, Robin

AU - Mawhorter, Steven D.

AU - McNeill, Ann

AU - Cook, Daniel

AU - Ratliff, Norman B.

AU - Pelegrin, David

AU - Colosimo, Phyllis

AU - Kiefer, Karen

AU - Ludrosky, Kristin

AU - Hobbs, Robert

AU - Taylor, David

AU - Buda, Tiffany

AU - Yeager, Michael

AU - Young, James B.

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AU - Starling, Randall C.

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