The Impact of Hypogammaglobulinemia on Infection Outcome in Patients Undergoing Ventricular Assist Device Implantation

Mohamad H. Yamani, Hsuan Hung Chuang, Volkan Ozduran, Robin K. Avery, Steven D. Mawhorter, Daniel J. Cook, Cathy Zilka, Kimberly Zeroske, Tiffany Buda, Robert E. Hobbs, David O. Taylor, Nicholas G. Smedira, Randall C. Starling

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Background: Infection is a major comorbidity after ventricular assist device (VAD) placement. Defects in cellular immunity have been reported after VAD placement. However, to our knowledge, quantitative immunoglobulin G (IgG) level determination and the impact of hypogammaglobulinemia (HGG) on infections after VAD implantation have not been evaluated before. Methods: A total of 76 patients (mean age, 53 years) underwent VAD implantation as a bridge to transplantation and had IgG levels determined as a baseline before transplantation. Patients were divided into 2 groups according to IgG level: Control Group (n = 56, IgG ≥ 700 mg/dl) and HGG Group (n = 20, IgG < 700 mg/dl). Infection outcome during the VAD course and after transplantation was analyzed in relation to the IgG level. Results: Baseline characteristics were similar in both groups. The incidence of bacteremia (14/20 [70%] vs 18/56 [32%], p = 0.0032) and major infection (19/20 [95%] vs 31/56 [56%], p = 0.0009) were significantly increased in the HGG Group compared with the Control Group. After transplantation, the episodes of rejection were similar in both groups and survival was similar. The HGG Group experienced more cytomegalovirus infections compared with the Control Group (9/20 [45%] vs 9/56 [16%], p = 0.009). Conclusions: VAD patients with HGG are at increased risk of infections. After transplantation, these patients also experience increased cytomegalovirus infections. A randomized preemptive IgG replacement trial may be warranted in the future to determine if this intervention will alleviate the risk of infection.

Original languageEnglish (US)
Pages (from-to)820-824
Number of pages5
JournalJournal of Heart and Lung Transplantation
Volume25
Issue number7
DOIs
StatePublished - Jul 1 2006

ASJC Scopus subject areas

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

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    Yamani, M. H., Chuang, H. H., Ozduran, V., Avery, R. K., Mawhorter, S. D., Cook, D. J., Zilka, C., Zeroske, K., Buda, T., Hobbs, R. E., Taylor, D. O., Smedira, N. G., & Starling, R. C. (2006). The Impact of Hypogammaglobulinemia on Infection Outcome in Patients Undergoing Ventricular Assist Device Implantation. Journal of Heart and Lung Transplantation, 25(7), 820-824. https://doi.org/10.1016/j.healun.2006.03.009