Robertson John, Elidemir Okan, Saz Eylem Ulas, Gulen Figen, Schecter Marc, McKenzie Emmet, Heinle Jeffrey, Smith E, Mallory George
Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Pediatr Transplant. 2009 Sep;13(6):754-9. doi: 10.1111/j.1399-3046.2008.01067.x. Epub 2008 Nov 1.
Infection is the leading cause of morbidity and mortality in the first year following lung transplantation. HG after adult lung transplantation has been associated with increased infections and hospitalization as well as decreased survival. The purpose of this study is to define the incidence, risk factors, and outcomes of HG in the first year following pediatric lung transplantation. A retrospective review of all lung transplant recipients at a single pediatric center over a four-yr period was performed. All serum Ig levels drawn within one yr of transplantation were recorded. An association between HG during the first year after transplantation and age, race, gender, diagnosis leading to transplantation and clinical outcomes including hospitalization, infections requiring hospitalization, viremia, fungal recovery from BAL lavage, and mortality was sought. HG was defined using age-based norms. Fifty-one charts were reviewed. Mean (+/-s.d.) post-transplantation levels for IgG, IgA, and IgM were 439.9 +/- 201.3, 82.3 +/- 50.2, and 75.2 +/- 41.4 mg/dL, respectively. HG was present in 48.8%, 12.2%, and 17.1% of patients for IgG, IgA, and IgM, respectively. Patients with HG for IgG were older (14.3 +/- 3.8 vs. 9.2 +/- 5.4 yr; p < 0.01). IgA and IgM HG were associated with invasive aspergillosis (p < 0.01 and p = 0.05, respectively). IgG and IgM levels inversely correlated with bacterial infections and hospital days, respectively (p < 0.01, p < 0.05). HG is a frequent complication following pediatric lung transplantation. Low Ig levels are associated with increased infections and hospital stay.
感染是肺移植后第一年发病和死亡的主要原因。成人肺移植后的低丙种球蛋白血症与感染增加、住院率上升以及生存率降低有关。本研究的目的是确定小儿肺移植后第一年低丙种球蛋白血症的发生率、危险因素和预后。对一家儿科中心4年内所有肺移植受者进行了回顾性研究。记录移植后1年内采集的所有血清免疫球蛋白水平。研究移植后第一年低丙种球蛋白血症与年龄、种族、性别、导致移植的诊断以及包括住院、需要住院治疗的感染、病毒血症、支气管肺泡灌洗真菌检出、死亡率在内的临床结局之间的关联。低丙种球蛋白血症根据基于年龄的标准定义。共审查了51份病历。移植后IgG、IgA和IgM的平均（±标准差）水平分别为439.9±201.3、82.3±50.2和75.2±41.4mg/dL。IgG、IgA和IgM低丙种球蛋白血症患者分别占48.8%、12.2%和17.1%。IgG低丙种球蛋白血症患者年龄较大（14.3±3.8岁对9.2±5.4岁；p<0.01）。IgA和IgM低丙种球蛋白血症与侵袭性曲霉病相关（分别为p<0.01和p=0.05）。IgG和IgM水平分别与细菌感染和住院天数呈负相关（p<0.01，p<0.05）。低丙种球蛋白血症是小儿肺移植后的常见并发症。低免疫球蛋白水平与感染增加和住院时间延长有关。
