Abstract

Background Severe hypogammaglobulinemia (HGG) (IgG <400 mg/dL) following intestinal transplantation is common. Although IgG replacement therapy is commonly used, clinical outcomes associated with increasing IgG levels to >400 mg/dL are not well described. Methods Kaplan-Meier analysis was performed to estimate survival, the log-rank test to compare survival distributions between groups, and the Fisher exact test to determine the association between HGG and rejection. Results A total of 23 intestinal transplant (IT) recipients with a median age of 2.3 years (range, 0.7-41 years) at the time of HGG diagnosis were included. The types of transplants were liver-small bowel (73.9%), liver-small bowel-kidney (8.7%), and small bowel only (17.4%). The 3-year survival after the diagnosis of HGG was 50.2% (95% confidence interval [CI] = 28.2%-68.7%). There was no difference in survival (P =.67) when patients were dichotomized based upon IgG level at last follow-up (IgG ≥400 mg/dL, n = 14; and IgG <400 mg/dL, n = 9). There was no also evidence of an association between survival and: total dose (P =.58), frequency (P =.11), and number of IgG doses administered (P =.8). There was no difference in survival between patients receiving (n = 12) or not receiving (n = 11) cytomegalovirus hyperimmunoglobulin (P =.10). Conclusions Improved survival rates were not found in our IT recipients with severe HGG with immunoglobulin therapy to IgG levels of ≥400 mg/dL, even when cytomegalovirus hyperimmunoglobulin was administered.

Original languageEnglish (US)
Pages (from-to)479-484
Number of pages6
JournalTransplantation Proceedings
Volume48
Issue number2
DOIs
StatePublished - Mar 1 2016

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Agammaglobulinemia
Passive Immunization
Immunoglobulin G
Survival
Cytomegalovirus
Liver
Kaplan-Meier Estimate
Transplant Recipients
Survival Rate
Confidence Intervals
Transplants
Kidney

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

@article{cc56216ead3448c799ac997f5ebb96ae,
title = "Impact of Immunoglobulin Therapy in Intestinal Transplant Recipients with Posttransplantation Hypogammaglobulinemia",
abstract = "Background Severe hypogammaglobulinemia (HGG) (IgG <400 mg/dL) following intestinal transplantation is common. Although IgG replacement therapy is commonly used, clinical outcomes associated with increasing IgG levels to >400 mg/dL are not well described. Methods Kaplan-Meier analysis was performed to estimate survival, the log-rank test to compare survival distributions between groups, and the Fisher exact test to determine the association between HGG and rejection. Results A total of 23 intestinal transplant (IT) recipients with a median age of 2.3 years (range, 0.7-41 years) at the time of HGG diagnosis were included. The types of transplants were liver-small bowel (73.9{\%}), liver-small bowel-kidney (8.7{\%}), and small bowel only (17.4{\%}). The 3-year survival after the diagnosis of HGG was 50.2{\%} (95{\%} confidence interval [CI] = 28.2{\%}-68.7{\%}). There was no difference in survival (P =.67) when patients were dichotomized based upon IgG level at last follow-up (IgG ≥400 mg/dL, n = 14; and IgG <400 mg/dL, n = 9). There was no also evidence of an association between survival and: total dose (P =.58), frequency (P =.11), and number of IgG doses administered (P =.8). There was no difference in survival between patients receiving (n = 12) or not receiving (n = 11) cytomegalovirus hyperimmunoglobulin (P =.10). Conclusions Improved survival rates were not found in our IT recipients with severe HGG with immunoglobulin therapy to IgG levels of ≥400 mg/dL, even when cytomegalovirus hyperimmunoglobulin was administered.",
author = "Poole, {Jill A} and F. Qiu and Kalil, {Andre C} and W. Grant and Mercer, {David F} and Florescu, {Diana F}",
year = "2016",
month = "3",
day = "1",
doi = "10.1016/j.transproceed.2015.12.064",
language = "English (US)",
volume = "48",
pages = "479--484",
journal = "Transplantation Proceedings",
issn = "0041-1345",
publisher = "Elsevier USA",
number = "2",

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TY - JOUR

T1 - Impact of Immunoglobulin Therapy in Intestinal Transplant Recipients with Posttransplantation Hypogammaglobulinemia

AU - Poole, Jill A

AU - Qiu, F.

AU - Kalil, Andre C

AU - Grant, W.

AU - Mercer, David F

AU - Florescu, Diana F

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Background Severe hypogammaglobulinemia (HGG) (IgG <400 mg/dL) following intestinal transplantation is common. Although IgG replacement therapy is commonly used, clinical outcomes associated with increasing IgG levels to >400 mg/dL are not well described. Methods Kaplan-Meier analysis was performed to estimate survival, the log-rank test to compare survival distributions between groups, and the Fisher exact test to determine the association between HGG and rejection. Results A total of 23 intestinal transplant (IT) recipients with a median age of 2.3 years (range, 0.7-41 years) at the time of HGG diagnosis were included. The types of transplants were liver-small bowel (73.9%), liver-small bowel-kidney (8.7%), and small bowel only (17.4%). The 3-year survival after the diagnosis of HGG was 50.2% (95% confidence interval [CI] = 28.2%-68.7%). There was no difference in survival (P =.67) when patients were dichotomized based upon IgG level at last follow-up (IgG ≥400 mg/dL, n = 14; and IgG <400 mg/dL, n = 9). There was no also evidence of an association between survival and: total dose (P =.58), frequency (P =.11), and number of IgG doses administered (P =.8). There was no difference in survival between patients receiving (n = 12) or not receiving (n = 11) cytomegalovirus hyperimmunoglobulin (P =.10). Conclusions Improved survival rates were not found in our IT recipients with severe HGG with immunoglobulin therapy to IgG levels of ≥400 mg/dL, even when cytomegalovirus hyperimmunoglobulin was administered.

AB - Background Severe hypogammaglobulinemia (HGG) (IgG <400 mg/dL) following intestinal transplantation is common. Although IgG replacement therapy is commonly used, clinical outcomes associated with increasing IgG levels to >400 mg/dL are not well described. Methods Kaplan-Meier analysis was performed to estimate survival, the log-rank test to compare survival distributions between groups, and the Fisher exact test to determine the association between HGG and rejection. Results A total of 23 intestinal transplant (IT) recipients with a median age of 2.3 years (range, 0.7-41 years) at the time of HGG diagnosis were included. The types of transplants were liver-small bowel (73.9%), liver-small bowel-kidney (8.7%), and small bowel only (17.4%). The 3-year survival after the diagnosis of HGG was 50.2% (95% confidence interval [CI] = 28.2%-68.7%). There was no difference in survival (P =.67) when patients were dichotomized based upon IgG level at last follow-up (IgG ≥400 mg/dL, n = 14; and IgG <400 mg/dL, n = 9). There was no also evidence of an association between survival and: total dose (P =.58), frequency (P =.11), and number of IgG doses administered (P =.8). There was no difference in survival between patients receiving (n = 12) or not receiving (n = 11) cytomegalovirus hyperimmunoglobulin (P =.10). Conclusions Improved survival rates were not found in our IT recipients with severe HGG with immunoglobulin therapy to IgG levels of ≥400 mg/dL, even when cytomegalovirus hyperimmunoglobulin was administered.

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U2 - 10.1016/j.transproceed.2015.12.064

DO - 10.1016/j.transproceed.2015.12.064

M3 - Article

C2 - 27109982

AN - SCOPUS:84964491019

VL - 48

SP - 479

EP - 484

JO - Transplantation Proceedings

JF - Transplantation Proceedings

SN - 0041-1345

IS - 2

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