Acquired hypogammaglobulinemia in HIV-positive subjects after liver transplantation.

Abstract

INTRODUCTION:

As more solid organ transplantations are performed in patients infected with human immunodeficiency virus (HIV), post-transplant complications in this population are becoming better defined.

METHODS:

Using serum samples from the Solid Organ Transplantation in HIV: Multi-Site Study, we studied the epidemiology of acquired hypogammaglobulinemia (HGG) after liver transplantation (LT) in 79 HIV-infected individuals with a median CD4 count at enrollment of 288 (interquartile range 200-423) cells/μL. Quantitative immunoglobulin G (IgG) levels before and after LT were measured, with moderate and severe HGG defined as IgG 350-500 mg/dL and <350 mg/dL, respectively. Incidence, risk factors, and associated outcomes of moderate or worse HGG were evaluated using Kaplan-Meier estimator and proportional hazards (PH) models.

RESULTS:

The 1-year cumulative incidence of moderate or worse HGG was 12% (95% confidence interval [CI]: 6-22%); no new cases were observed between years 1 and 2. In a multivariate PH model, higher pre-transplant model for end-stage liver disease score (P = 0.04) and treated acute rejection (P = 0.04) were both identified as significant predictors of moderate or worse HGG. There was a strong association of IgG levels <500 mg/dL with non-opportunistic serious infection (hazard ratio [95% CI]: 3.5 [1.1-10.6]; P = 0.03) and mortality (3.2 [1.1-9.4]; P = 0.04). These associations held after adjustment for important determinants of infection and survival among the entire cohort.

CONCLUSION:

These results suggest that a proportion of HIV-positive LT recipients will develop clinically significant HGG after transplantation.

• Authors: K S Gregg, B Barin, D Pitrak, C Ramaprasad, K Pursell
• Journal: Transplant infectious disease : an official journal of the Transplantation Society (Transpl Infect Dis) Vol. 15 Issue 6 Pg. 581-7 (Dec 2013) ISSN: 1399-3062 [Electronic] Denmark
• PMID: 24103022 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
• Copyright: © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Immunoglobulin G

Topics

• Adult
• Bacterial Infections (epidemiology)
• CD4 Lymphocyte Count
• Common Variable Immunodeficiency (blood, epidemiology)
• Cytomegalovirus Infections (epidemiology)
• End Stage Liver Disease (surgery)
• Female
• Follow-Up Studies
• Graft Rejection (epidemiology)
• HIV Seropositivity (blood, complications)
• Humans
• Immunoglobulin G (blood)
• Incidence
• Kaplan-Meier Estimate
• Liver Transplantation (adverse effects, mortality)
• Male
• Middle Aged
• Mycoses (epidemiology)
• Proportional Hazards Models
• Risk Factors
• Severity of Illness Index