Article,
Bronchiolitis obliterans syndrome, hypogammaglobulinemia, and infectious complications of lung transplantation.
J Heart Lung Transplant, 32 (1): 36--43 (January 2013)
DOI: 10.1016/j.healun.2012.10.006
Abstract
Because infection has been associated with the development of bronchiolitis obliterans syndrome (BOS), we hypothesized that post-transplant hypogammaglobulinemia would be associated with infection and BOS.Cross-sectional levels of serum immunoglobulins were measured on 2 occasions in our transplant cohort and models developed to explain serum immunoglobulin levels and BOS-free survival.A total of 139 patients (median age, 46.6 years) were evaluated at 47 months (range, 15-74 months) after transplant, and 87 were re-evaluated at 72 months (40-107 months). Of this cohort, 44\% were immunoglobulin (Ig) G deficient and levels remained stable across the study period, and 27\% were IgA deficient and levels fell slightly over time (p = 0.003). Both immunoglobulin classes were lower in patients with a history of invasive fungal infection, whereas IgA levels were lower in patients with a history of community-acquired respiratory viral infection. Low IgG was independently associated with shorter BOS-free survival (hazard ratio, 0.79; 95\% confidence interval, 0.71-0.88; p<0.001).Serum immunoglobulin deficiency is common after lung transplantation and is associated with community-acquired respiratory viral infection, invasive fungal infection, and BOS.
