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

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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 2006
Externally publishedYes

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Agammaglobulinemia
Heart-Assist Devices
Immunoglobulin G
Transplantation
Infection
Cytomegalovirus Infections
Control Groups
Bacteremia
Cellular Immunity
Comorbidity
Survival
Incidence

ASJC Scopus subject areas

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

Cite this

Yamani, M. H., Chuang, H. H., Ozduran, V., Avery, R. K., Mawhorter, S. D., Cook, D. J., ... 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

The Impact of Hypogammaglobulinemia on Infection Outcome in Patients Undergoing Ventricular Assist Device Implantation. / Yamani, Mohamad H.; Chuang, Hsuan Hung; Ozduran, Volkan; Avery, Robin K.; Mawhorter, Steven D.; Cook, Daniel J.; Zilka, Cathy; Zeroske, Kimberly; Buda, Tiffany; Hobbs, Robert E.; Taylor, David O.; Smedira, Nicholas G.; Starling, Randall C.

In: Journal of Heart and Lung Transplantation, Vol. 25, No. 7, 07.2006, p. 820-824.

Research output: Contribution to journalArticle

Yamani, MH, Chuang, HH, Ozduran, V, Avery, RK, Mawhorter, SD, Cook, DJ, Zilka, C, Zeroske, K, Buda, T, Hobbs, RE, Taylor, DO, Smedira, NG & Starling, RC 2006, 'The Impact of Hypogammaglobulinemia on Infection Outcome in Patients Undergoing Ventricular Assist Device Implantation', Journal of Heart and Lung Transplantation, vol. 25, no. 7, pp. 820-824. https://doi.org/10.1016/j.healun.2006.03.009
Yamani, Mohamad H. ; Chuang, Hsuan Hung ; Ozduran, Volkan ; Avery, Robin K. ; Mawhorter, Steven D. ; Cook, Daniel J. ; Zilka, Cathy ; Zeroske, Kimberly ; Buda, Tiffany ; Hobbs, Robert E. ; Taylor, David O. ; Smedira, Nicholas G. ; Starling, Randall C. / The Impact of Hypogammaglobulinemia on Infection Outcome in Patients Undergoing Ventricular Assist Device Implantation. In: Journal of Heart and Lung Transplantation. 2006 ; Vol. 25, No. 7. pp. 820-824.
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title = "The Impact of Hypogammaglobulinemia on Infection Outcome in Patients Undergoing Ventricular Assist Device Implantation",
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.",
author = "Yamani, {Mohamad H.} and Chuang, {Hsuan Hung} and Volkan Ozduran and Avery, {Robin K.} and Mawhorter, {Steven D.} and Cook, {Daniel J.} and Cathy Zilka and Kimberly Zeroske and Tiffany Buda and Hobbs, {Robert E.} and Taylor, {David O.} and Smedira, {Nicholas G.} and Starling, {Randall C.}",
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T1 - The Impact of Hypogammaglobulinemia on Infection Outcome in Patients Undergoing Ventricular Assist Device Implantation

AU - Yamani, Mohamad H.

AU - Chuang, Hsuan Hung

AU - Ozduran, Volkan

AU - Avery, Robin K.

AU - Mawhorter, Steven D.

AU - Cook, Daniel J.

AU - Zilka, Cathy

AU - Zeroske, Kimberly

AU - Buda, Tiffany

AU - Hobbs, Robert E.

AU - Taylor, David O.

AU - Smedira, Nicholas G.

AU - Starling, Randall C.

PY - 2006/7

Y1 - 2006/7

N2 - 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.

AB - 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.

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