Recipients of solid organ allografts require lifelong immunosuppression in order to prevent graft rejection and to maintain graft function. In general, such immunosuppression greatly impairs the cellular immune system, as this level of the immune system is principally responsible for self and non-self recognition. The consequences of allograft
transplantation in terms of patient and graft survival when transplants are given to individuals who have a preexisting humoral immune deficiency characterized by a deficiency of the serum levels of one or more of the major Ig classes have not yet been reported. From February 1, 1981 through December 31, 1990, a total of 43 adult patients with a deficiency of 1 or more Ig classes received a ABO-matched liver allograft at this institution. This sample represents 2.5% of a total of 1684 adults transplanted during this interval. These 43 liver graft recipients could be divided into 3 major groups based upon the presence of an
IgG,
IgM, or
IgA deficiency.
IgG deficiencies were defined as levels less than 50 mg/dl. Patient and graft survival for the
IgA-deficient group was significantly reduced (P less than 0.04 and P less than 0.009, respectively) compared with both the
IgG- and
IgM-deficient groups. The latter two groups did not differ from controls without an Ig deficiency for these same two endpoints. The major causes of death in the
IgA-deficient group were
sepsis and
opportunistic infection. A third of the deaths in the
IgA-deficient group occurred in the
perioperative period (first 30 days) while greater than 50% of the deaths occurred within the first 3 months, and all deaths occurred before the first year. Based upon these data, the following conclusions can be made: (1) serum
IgA deficiency but not
IgG or
IgM deficiency is associated with an increased post-OLTx death and graft loss rate; (2) the majority of these deaths are due to
sepsis or an
opportunistic infection; and (3) most of the deaths occur early. These data suggest that recognition of a deficiency of
IgA prior to
organ grafting necessitates meticulous attention to the prevention of
infection in the immediate
perioperative period if patient and graft survival of these patients is to be improved.