Doron Shira, Ruthazer Robin, Werner Barbara G, Rabson Arthur, Snydman David R
Division of Geographic Medicine and Infectious Diseases, Tufts-New England Medical Center, Boston, MA 02111, USA.
Transplantation. 2006 Mar 15;81(5):697-703. doi: 10.1097/01.tp.0000180531.66518.9e.
Recent studies suggest a substantial incidence of posttransplant hypogammaglobulinemia and an association with infection.
We conducted a retrospective analysis of immunoglobulin (Ig) G levels from blood prospectively collected during a randomized double-blind placebo-controlled trial of cytomegalovirus (CMV) immune globulin that included 146 patients who underwent liver transplantation between December 1987 and June 1990. Serum samples collected at baseline and approximately weeks 4, 8, 12, 16, 24, and 32 posttransplant were analyzed. Hypogammaglobulinemia was defined as having at least one IgG level below 560 mg/dl. A variety of variables were analyzed as potential risk factors and outcomes of hypogammaglobulinemia.
A total of 613 samples from 112 patients were analyzed. Twenty-nine (26%) patients had posttransplant hypogammaglobulinemia. Fourteen (12.5%) had hypogammaglobulinemia at the time of their baseline measurement. There was a strong association between hypogammaglobulinemia and both one-year (P=0.0490) and five-year mortality (P=0.0187), even when adjusted for variables known to be associated with mortality (HR for one-year mortality 3.08, confidence interval 1.20, 7.91). Risk factors for hypogammaglobulinemia included only non A/non B hepatitis and "other diagnosis" (a category made up of rare causes of liver disease). None of the infectious outcomes examined, including CMV infection, CMV disease, bacteremia or invasive fungal disease, or rejection were significantly associated with hypogammaglobulinemia.
In orthotopic liver transplant recipients we found a 26% incidence of posttransplant hypogammaglobulinemia. Approximately half of these patients were hypogammaglobulinemic at baseline. A strong association between hypogammaglobulinemia and mortality was seen. Prospective studies are needed to further elucidate the risk factors and outcomes of posttransplant hypogammaglobulinemia.
近期研究表明，移植后低丙种球蛋白血症的发生率颇高，且与感染相关。
我们对在一项关于巨细胞病毒（CMV）免疫球蛋白的随机双盲安慰剂对照试验中前瞻性收集的血液中的免疫球蛋白（Ig）G水平进行了回顾性分析。该试验纳入了1987年12月至1990年6月期间接受肝移植的146例患者。分析了在基线以及移植后约4、8、12、16、24和32周采集的血清样本。低丙种球蛋白血症定义为至少有一次IgG水平低于560mg/dl。分析了多种变量作为低丙种球蛋白血症的潜在危险因素和结果。
共分析了来自112例患者的613份样本。29例（26%）患者发生了移植后低丙种球蛋白血症。14例（12.5%）在基线测量时即存在低丙种球蛋白血症。低丙种球蛋白血症与一年（P=0.0490）和五年死亡率（P=0.0187）均存在密切关联，即便对已知与死亡率相关的变量进行校正后亦是如此（一年死亡率的风险比为3.08，置信区间为1.20至7.91）。低丙种球蛋白血症的危险因素仅包括非甲/非乙型肝炎和“其他诊断”（由罕见肝病病因组成的类别）。所检查的任何感染性结局，包括CMV感染、CMV疾病、菌血症或侵袭性真菌病，以及排斥反应，均与低丙种球蛋白血症无显著关联。
在原位肝移植受者中，我们发现移植后低丙种球蛋白血症的发生率为26%。这些患者中约一半在基线时即存在低丙种球蛋白血症。可见低丙种球蛋白血症与死亡率之间存在密切关联。需要进行前瞻性研究以进一步阐明移植后低丙种球蛋白血症的危险因素和结果。
