Kawut Steven M, Shah Lori, Wilt Jessie S, Dwyer Edward, Maani Patricia A, Daly Theresa M, O'Shea Mitchell K, Sonett Joshua R, Arcasoy Selim M
Department of Medicine, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, NY 10032, USA.
Transplantation. 2005 Jun 27;79(12):1723-6. doi: 10.1097/01.tp.0000159136.72693.35.
Hypogammaglobulinemia (HGG) frequently occurs after solid organ transplantation; however, the prevalence and implications of HGG after lung transplantation are not well defined. The authors aimed to define the prevalence, risk factors, and outcomes of patients with severe HGG after lung transplantation. METHODS.: The authors performed a retrospective cohort study of 57 lung transplant recipients at their center. Quantitative total and subclass immunoglobulin (Ig) G levels were obtained from patients.
Thirty-four (60%; 95% confidence interval [CI], 46%-72%) patients had low IgG levels (IgG <700 mg/dL); of these, eight (14%; 95% CI, 6%-26%) had severe HGG (IgG <400 mg/dL). Female patients had a higher risk of severe HGG than male patients (25% vs. 0%, P=0.007), and patients who underwent transplantation for emphysema had a higher risk of severe HGG than others (P=0.04). Patients with bronchiolitis obliterans syndrome had a higher risk of severe HGG than those without (50% vs. 10%, P=0.03). Severe HGG was associated with an increased risk of pneumonia (P=0.01) and worse survival (P=0.04) but with neither the incidence of cytomegalovirus disease (P=0.54) nor a subsequent diagnosis of bronchiolitis obliterans syndrome (P=0.70).
The authors have documented a high prevalence of HGG after lung transplantation. Emphysema, female gender, and bronchiolitis obliterans syndrome are risk factors for severe HGG. Patients with severe HGG had a higher cumulative incidence of pneumonia and worse survival. Studies of the efficacy and safety of IgG supplementation after lung transplantation should be pursued.
低丙种球蛋白血症（HGG）在实体器官移植后经常发生；然而，肺移植后HGG的患病率及其影响尚未明确界定。作者旨在明确肺移植后严重HGG患者的患病率、危险因素及预后情况。
作者对其中心的57例肺移植受者进行了一项回顾性队列研究。从患者处获取定量的总免疫球蛋白（Ig）G水平和亚类免疫球蛋白G水平。
34例（60%；95%置信区间[CI]，46%-72%）患者的IgG水平较低（IgG<700mg/dL）；其中，8例（14%；95%CI，6%-26%）患有严重HGG（IgG<400mg/dL）。女性患者发生严重HGG的风险高于男性患者（25%对0%，P=0.007），因肺气肿接受移植的患者发生严重HGG的风险高于其他患者（P=0.04）。闭塞性细支气管炎综合征患者发生严重HGG的风险高于无该综合征的患者（50%对10%，P=0.03）。严重HGG与肺炎风险增加（P=0.01）及生存情况较差（P=0.04）相关，但与巨细胞病毒病的发生率（P=0.54）及随后闭塞性细支气管炎综合征的诊断（P=0.70）均无关。
作者记录了肺移植后HGG的高患病率。肺气肿、女性性别及闭塞性细支气管炎综合征是严重HGG的危险因素。严重HGG患者肺炎累积发生率较高且生存情况较差。应开展关于肺移植后补充IgG的疗效和安全性的研究。
