Infectious Diseases Division, University of Nebraska Medical Center, Omaha, NE; Transplant Surgery Division, University of Nebraska Medical Center, Omaha, NE.
Am J Transplant. 2013 Oct;13(10):2601-10. doi: 10.1111/ajt.12401. Epub 2013 Aug 6.
Hypogammaglobulinemia has been described after solid organ transplantation and has been associated with increased risk of infections. The aim of the study was to evaluate the rate of severe hypogammaglobulinemia and its relationship with the risk of infections during the first year posttransplantation. Eighteen studies (1756 patients) that evaluated hypogammaglobulinemia and posttransplant infections were included. The data were pooled using the DerSimonian and Laird random-effects model. Q statistic method was used to assess statistical heterogeneity. Within the first year posttransplantation, the rate of hypogammaglobulinemia (IgG < 700 mg/dL) was 45% (95% CI: 0.34-0.55; Q = 330.1, p < 0.0001), the rate of mild hypogammaglobulinemia (IgG = 400-700 mg/dL) was 39% (95% CI: 0.22-0.56; Q = 210.09, p < 0.0001) and the rate of severe hypogammaglobulinemia (IgG < 400 mg/dL) was 15% (95% CI: 0.08-0.22; Q = 50.15, p < 0.0001). The rate of hypogammaglobulinemia by allograft type: heart 49% (21%-78%; Q = 131.16, p < 0.0001); kidney 40% (30%-49%; Q = 24.55, p = 0.0002); liver 16% (0.001%-35%; Q = 14.31, p = 0.0002) and lung 63% (53%-74%; Q = 6.85, p = 0.08). The odds of respiratory infection (OR = 4.83; 95% CI: 1.66-14.05; p = 0.004; I(2) = 0%), CMV (OR = 2.40; 95% CI: 1.16-4.96; p = 0.02; I(2) = 26.66%), Aspergillus (OR = 8.19; 95% CI: 2.38-28.21; p = 0.0009; I(2) = 17.02%) and other fungal infections (OR = 3.69; 95% CI: 1.11-12.33; p = 0.03; I(2) = 0%) for patients with IgG < 400 mg/dL were higher than the odds for patients with IgG > 400 mg/dL. The odds for 1-year all-cause mortality for severe hypogammaglobulinemia group was 21.91 times higher than those for IgG > 400 mg/dL group (95% CI: 2.49-192.55; p = 0.005; I(2) = 0%). Severe hypogammaglobulinemia during the first year posttransplantation significantly increased the risk of CMV, fungal and respiratory infections, and was associated with higher 1-year all-cause mortality.
移植术后低丙种球蛋白血症已被描述，并与感染风险增加相关。本研究旨在评估移植后第一年发生严重低丙种球蛋白血症的发生率及其与感染风险的关系。共纳入了 18 项评估低丙种球蛋白血症和移植后感染的研究（1756 例患者）。使用 DerSimonian 和 Laird 随机效应模型对数据进行汇总。采用 Q 统计量法评估统计学异质性。移植后第一年，低丙种球蛋白血症（IgG < 700 mg/dL）的发生率为 45%（95%CI：0.34-0.55；Q = 330.1，p < 0.0001），轻度低丙种球蛋白血症（IgG = 400-700 mg/dL）的发生率为 39%（95%CI：0.22-0.56；Q = 210.09，p < 0.0001），严重低丙种球蛋白血症（IgG < 400 mg/dL）的发生率为 15%（95%CI：0.08-0.22；Q = 50.15，p < 0.0001）。按同种异体移植物类型划分的低丙种球蛋白血症发生率：心脏 49%（21%-78%；Q = 131.16，p < 0.0001）；肾脏 40%（30%-49%；Q = 24.55，p = 0.0002）；肝脏 16%（0.001%-35%；Q = 14.31，p = 0.0002）和肺 63%（53%-74%；Q = 6.85，p = 0.08）。呼吸道感染的比值比（OR）为 4.83（95%CI：1.66-14.05；p = 0.004；I(2) = 0%）、巨细胞病毒（OR）为 2.40（95%CI：1.16-4.96；p = 0.02；I(2) = 26.66%）、曲霉（OR）为 8.19（95%CI：2.38-28.21；p = 0.0009；I(2) = 17.02%）和其他真菌感染（OR）为 3.69（95%CI：1.11-12.33；p = 0.03；I(2) = 0%）的风险高于 IgG > 400 mg/dL 的患者。严重低丙种球蛋白血症组的 1 年全因死亡率的比值比为 IgG > 400 mg/dL 组的 21.91 倍（95%CI：2.49-192.55；p = 0.005；I(2) = 0%）。移植后第一年严重低丙种球蛋白血症显著增加了巨细胞病毒、真菌感染和呼吸道感染的风险，与 1 年全因死亡率升高相关。
