Ohsumi Akihiro, Chen Fengshi, Yamada Tetsu, Sato Masaaki, Aoyama Akihiro, Bando Toru, Date Hiroshi
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Eur J Cardiothorac Surg. 2014 Mar;45(3):e61-7. doi: 10.1093/ejcts/ezt583. Epub 2014 Jan 8.
Recent studies suggest hypogammaglobulinemia (HGG) is frequently associated with infection after solid organ transplantation, although the effects of HGG after lung transplantation are not well recognized. We investigated the incidence and degree of HGG after lung transplantation and its association with infection.
A retrospective cohort study analysing pre- and post-transplant IgA, IgG and IgM levels and infectious events in patients undergoing living-donor lobar and cadaveric lung transplantation at Kyoto University Hospital between June 2008 and March 2013.
Overall, post-transplant immunoglobulin (Ig) levels were significantly lower than pretransplant levels. In almost all patients who received transplants for bronchiolitis obliterans (BO) after haematopoietic stem cell transplantation (HSCT), interstitial lung diseases and bronchiectasis, post-transplant IgA and IgG levels decreased and were significantly lower than pretransplant levels; pre- and post-transplant IgA and pretransplant IgG levels were significantly lower in patients transplanted for BO after HSCT than in the others. Post-transplant IgG levels in patients transplanted for BO after HSCT also tended to be lower than those in the others, but not significantly. Nineteen of 29 patients had HGG after lung transplantation (65.5%) and had more infections than the normal gammaglobulinemia group, although there was no significant difference. Among them, 2 patients transplanted for BO after HSCT with quite low HGG had severe pneumonia and finally died.
Post-transplant Ig levels were significantly lower than pretransplant levels. Although without significant difference, HGG patients had more infections, above all, those with severe HGG transplanted for BO after HSCT could have lethal infections. Ig levels in HGG should be monitored carefully because severe HGG was associated with poor prognosis.
近期研究表明，低丙种球蛋白血症（HGG）在实体器官移植后常与感染相关，尽管肺移植后HGG的影响尚未得到充分认识。我们调查了肺移植后HGG的发生率、程度及其与感染的关系。
一项回顾性队列研究，分析2008年6月至2013年3月在京都大学医院接受活体供体肺叶移植和尸体肺移植患者的移植前后免疫球蛋白A（IgA）、免疫球蛋白G（IgG）和免疫球蛋白M（IgM）水平以及感染事件。
总体而言，移植后免疫球蛋白（Ig）水平显著低于移植前水平。几乎所有接受造血干细胞移植（HSCT）后因闭塞性细支气管炎（BO）、间质性肺疾病和支气管扩张而接受移植的患者，移植后IgA和IgG水平均下降，且显著低于移植前水平；HSCT后因BO接受移植的患者移植前IgA和移植前IgG水平显著低于其他患者。HSCT后因BO接受移植的患者移植后IgG水平也往往低于其他患者，但差异不显著。29例患者中有19例（65.5%）肺移植后发生HGG，且感染次数多于正常丙种球蛋白血症组，尽管差异无统计学意义。其中，2例HSCT后因BO接受移植且HGG水平极低的患者发生严重肺炎，最终死亡。
移植后Ig水平显著低于移植前水平。尽管差异无统计学意义，但HGG患者感染次数更多，尤其是HSCT后因BO接受移植且HGG严重的患者可能发生致命感染。应密切监测HGG患者的Ig水平，因为严重HGG与预后不良相关。
