Department of Surgery, Dumont University of California Los Angeles Transplant Center, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095, USA.
Transplantation. 2013 May 15;95(9):1154-9. doi: 10.1097/TP.0b013e3182869d05.
Despite recent advances in intestinal transplantation (ITx), infection (INF) and acute cellular rejection (ACR) remain major causes of patient and graft loss. Studies in other solid-organ transplantations indicate that low levels of serum immunoglobulin G (IgG) negatively impact outcomes. To date, there have been no studies on IgG after ITx.
A retrospective review of an IgG measurement protocol in primary ITx recipients between 2007 and 2011 was undertaken. IgG levels were measured at the time of evaluation, transplantation, and at weekly intervals for 2 months. Hypogammaglobulinemia (HGG) was defined as IgG levels below the lower limit of the 95% confidence interval for age. Associations between HGG, INF, and ACR were tested, and the incidence and timing of INF and ACR were compared.
Thirty-four patients were transplanted at a mean (SD) age of 12.4 (17.2) years. Most were Latino children with gastroschisis who received multivisceral grafts. Relative to pre-ITx levels, a statistically significant decrease in IgG levels was observed after ITx (P<0.05). Twenty patients (59%) developed HGG during the post-ITx period at a mean (SD) of 9.8 days. No significant associations were identified between HGG and INF or ACR.
This is the first study to describe serum IgG levels after ITx. A marked decrease in serum IgG levels was observed early on, in most patients. The etiology is potentially related to immunotherapy. HGG was not associated with INF or ACR, possibly related to the sample size and our practice of exogenous intravenous immunoglobulin replacement.
尽管肠移植（ITx）技术近来取得了进展，但感染（INF）和急性细胞排斥（ACR）仍然是导致患者和移植物丧失的主要原因。其他实体器官移植的研究表明，血清免疫球蛋白 G（IgG）水平低会对结果产生负面影响。迄今为止，尚无关于 ITx 后 IgG 的研究。
对 2007 年至 2011 年间进行的原发性 ITx 受者 IgG 测量方案进行了回顾性研究。在评估、移植时以及移植后 2 个月每周测量 IgG 水平。低丙种球蛋白血症（HGG）定义为 IgG 水平低于年龄 95%置信区间下限。测试了 HGG、INF 和 ACR 之间的相关性，并比较了 INF 和 ACR 的发生率和时间。
34 名患者在平均（SD）年龄为 12.4（17.2）岁时接受了移植。大多数患者为拉美裔儿童，患有先天性腹裂，接受了多脏器移植。与 ITx 前水平相比，ITx 后 IgG 水平显著下降（P<0.05）。20 名患者（59%）在 ITx 后期间平均（SD）在第 9.8 天出现 HGG。HGG 与 INF 或 ACR 之间未发现显著相关性。
这是第一项描述 ITx 后血清 IgG 水平的研究。大多数患者在早期观察到血清 IgG 水平明显下降。其病因可能与免疫治疗有关。HGG 与 INF 或 ACR 无关，这可能与样本量和我们使用外源性静脉注射免疫球蛋白替代治疗有关。
