Bronchiolitis obliterans syndrome, hypogammaglobulinemia, and infectious complications of lung transplantation
Section snippets
Methods
The study was approved by The Prince Charles Hospital Human Research and Ethics Committee.
Results
Full demographic data for the cohort are reported in Supplementary Table 1 (available on the JHLTonline.org Web site). Patients (48% women) were a median age of 46.6 years (IQR, 31.0–56.7 years) at transplantation. The diagnosis was cystic fibrosis in 34% and chronic obstructive pulmonary disease (COPD) in 37%. The transplant procedures were bilateral in 86%, single-lung in 7%, heart-lung in 5%, and heart-lung-liver in 2%. At the census, 51% of the cohort had a diagnosis of BOS grade≥ 1.
Discussion
We have found that serum IgG and IgA levels both fall after transplantation, with many patients having levels below the reference range, and that immunoglobulin deficiency places the lung transplant recipient at risk of CARV infection, invasive fungal infection, and BOS. Our findings suggest that immunoglobulin deficiency should be excluded in any patient presenting with 1 or more of these post-transplant complications.
Several groups have identified a similarly high prevalence (48% to 73%) of
Disclosure statement
The authors thank Jonathan Bleier, Biostatistician from Queensland Institute of Medical Research, for statistical advice and support.
Some of this work was presented at the Thirtieth Anniversary Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation, Chicago, Illinois, April 20–24, 2010.
None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to
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Practical guidance for the diagnosis and management of secondary hypogammaglobulinemia: A Work Group Report of the AAAAI Primary Immunodeficiency and Altered Immune Response Committees
2022, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Risk factors for post-LT SHG include basiliximab induction or mycophenolate use.24,252 Risk factors for post-LT severe SHG include female sex, COPD/emphysema, bronchiolitis obliterans, and less than 30% of pretransplant pneumococcal antibody levels being protective.24,252-254,256 Immune evaluation may be particularly warranted for patients undergoing LT for CF and COPD.
Low pretransplant IgA level is associated with early post–lung transplant seromucous infection
2018, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :However, in this paper, we focused on the possibility of pretransplant susceptibility (or predisposition) to posttransplant infection. IgA deficiency before lung transplantation has not been well studied, although it has been suggested that posttransplant IgA deficiency is associated with increased community-acquired pneumonia, invasive fungal infection, sepsis, and death.5,22 This is hypothesized to be secondary to weakened seromucous defenses.
Monitoring of early humoral immunity to identify lung recipients at risk for development of serious infections: A multicenter prospective study
2018, Journal of Heart and Lung TransplantationCitation Excerpt :Goldfarb et al8 demonstrated that IgG hypogammaglobulinemia was a risk factor for opportunistic infections. Chambers et al4 described lower IgG levels in lung recipients with fungal infections. This association was also suggested by Robertson et al5 in pediatric lung transplantation.
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