Published ahead of print on January 6, 2006, doi:10.1164/rccm.200510-1609OC Am. J. Respir. Crit. Care Med., Volume 173, Number 8, April 2006, 917-921 A more recent version of this article appeared on April 15, 2006
Submitted on October 14, 2005 Immunoglobulin G Levels Before and After Lung TransplantationNatalie H Yip1,1 Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA, 2 Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA; Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, USA, 3 Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY, USA, 4 Department of Statistics, Columbia University, New York, NY, USA * To whom correspondence should be addressed. E-mail: sa2059{at}columbia.edu.
Rationale: The determinants of immunoglobulin G level and the risk of hypogammaglobulinemia in patients with severe lung disease before and after lung transplantation are unknown. Objectives: We aimed to identify predictors of low immunoglobulin G levels before and after lung transplantation. Methods: We performed a retrospective cohort study of 40 consecutive lung transplant recipients at our center. Total immunoglobulin G levels were measured before and serially after transplantation. Mild hypogammaglobulinemia was defined as immunoglobulin G levels from 400-699 mg/dl; severe hypogammaglobulinemia was defined as immunoglobulin G levels < 400 mg/dl. Measurements and Main Results: Prior to transplantation, six (15%) patients had mild hypogammaglobulinemia and none had severe hypogammaglobulinemia. Patients with chronic obstructive pulmonary disease had lower immunoglobulin G levels compared to patients with other diseases (independent of corticosteroid use and age) (p=0.001) and an increased risk of mild hypogammaglobulinemia (p=0.005). The cumulative incidences of mild and severe hypogammaglobulinemia significantly increased after transplantation (58% and 15%, respectively, both p<0.04 compared to pre-transplant prevalences). Lower pre-transplant immunoglobulin G level and treatment with mycophenolate mofetil were associated with lower immunoglobulin G levels after transplantation (both p<0.05). Only lower pre-transplant immunoglobulin G levels were significantly associated with an increased risk of severe hypogammaglobulinemia after transplantation (p=0.02). Conclusions: Mild hypogammaglobulinemia is common in patients with severe chronic obstructive pulmonary disease, and the incidences of mild and severe hypogammaglobulinemia increase significantly early after lung transplantation. Baseline immunoglobulin G levels and treatment with mycophenolate mofetil both affect post-transplant immunoglobulin G levels. Key words: infection, immunosuppression, hypogammaglobulinemia, lung transplantation
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