Detrimental Association of Hypogammaglobulinemia With Chronic Lung Allograft Dysfunction and Death Is Not Mitigated by On-Demand Immunoglobulin G Replacement After Lung Transplantation

Alicia B Lichvar; Christopher R Ensor; Adriana Zeevi; Matthew R Morrell; Joseph M Pilewski; J W Awori Hayanga; Jonathan D'Cunha; John F McDyer; Andrej A Petrov

doi:10.1177/1526924818817028

Detrimental Association of Hypogammaglobulinemia With Chronic Lung Allograft Dysfunction and Death Is Not Mitigated by On-Demand Immunoglobulin G Replacement After Lung Transplantation

Prog Transplant. 2018 Dec 11:1526924818817028. doi: 10.1177/1526924818817028. Online ahead of print.

Authors

Alicia B Lichvar¹, Christopher R Ensor², Adriana Zeevi³, Matthew R Morrell², Joseph M Pilewski², J W Awori Hayanga⁴, Jonathan D'Cunha⁴, John F McDyer², Andrej A Petrov²

Affiliations

¹ 1 Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA.
² 2 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
³ 3 Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA.
⁴ 4 Division of Lung Transplant/Lung Failure, Department of Cardiothoracic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

PMID: 30537897
DOI: 10.1177/1526924818817028

Abstract

Background:: Hypogammaglobulinemia (HGG), immunoglobulin G (IgG) <700 mg/dL, is associated with infections, chronic lung allograft dysfunction, and death following lung transplantation. This study evaluates the use of on-demand intravenous IgG in lung transplant recipients with HGG.

Materials and methods:: This single-center retrospective cohort study of adult lung recipients evaluated 3 groups, no, untreated (u), or treated (t) HGG at first IgG administration or a matched time posttransplant. Primary outcome was freedom from allograft dysfunction. Secondary outcomes included development of advanced dysfunction, rejection, infection burden, and mortality.

Results:: Recipients included 484 (no HGG: 76, uHGG: 192, tHGG: 216). Freedom from chronic allograph dysfunction was highest in the non-HGG group 2 years post-enrollment (no HGG 77.9% vs uHGG 56.4% vs tHGG 52.5%; P = .002). Freedom from advanced dysfunction was significantly different 2 years post-enrollment (no HGG 90.5% vs uHGG 84.7% vs tHGG 75.4%; P = .017). Patients without HGG and those with uHGG had less mortality at 2 years post-enrollment (no HGG 84.2% vs uHGG 81.3% vs tHGG 64.8%; P < .001). Gram-negative pneumonias occurred more often in the tHGG group ( P = .02).

Conclusions:: Development of chronic lung allograft dysfunction, patient survival, rejection burden, and key infectious outcomes in lung transplant recipients were still problematic in the context of on-demand IgG therapy. Prospective studies are warranted.

Keywords: bacterial infections and mycoses; body regions; diseases; immune system; other transplant recipient; pathological conditions; population characteristics; signs and symptoms; therapeutics.