Efficacy of IgM-enriched Immunoglobulin for Vasopressor-resistant Vasoplegic Shock After Liver Transplantation.

Abstract

BACKGROUND:

Vasoplegia is a clinical condition typically manifested by cardiovascular instability unresponsive to the usual doses of inotropes or vasopressors. It can occur in a variety of clinical settings including liver transplantation (LT). Immunoglobulins have been used to treat sepsis-related vasoplegia. We performed a retrospective study to evaluate the efficacy of IgM-enriched immunoglobulin (IgMIg) on 30-day mortality and its ability to reverse vasoplegia in patients undergoing LT.

METHODS:

Between May 2013 and November 2017, 473 LT were performed at our institution. We identified 21 patients who received IgMIg for 3 days to treat vasoplegia. Patients included in the study met the criteria for having vasoplegia and required noradrenaline administration greater than 1 μg·kg·min for more than 24 hours to maintain a mean arterial pressure of 70 mm Hg or greater. Procalcitonin and interleukin-6 (IL-6) levels were used as surrogate markers for inflammation and were measured at the beginning and end of IgM treatment.

RESULTS:

After IgMIg administration, median noradrenaline infusion rates could be significantly reduced from 1.6 μg·kg·min (1.3-2 μg·kg·min) to 0.16 μg·kg·min (0.08-0.34 μg·kg·min) (P < 0.001). In addition, after treatment, procalcitonin levels decreased significantly from 44 ng/mL (24-158) to 26.1 ng/mL (10.9-48.7) (P < 0.001) and IL-6 levels decreased significantly from 63 pg/mL (29-102) to 20 pg/mL (11-20) (P < 0.001). Thirty-day morality was 14.3%.

CONCLUSIONS:

The administration of IgMIg in patients with vasoplegia after LT is associated with a return of hemodynamic stability. Despite a predicted mortality of over 90% by Sepsis-Related Organ Failure Assessment score, the mortality rate of patients receiving IgMIg in our study was less than 20%.

• Authors: Katharina Willuweit, Dmitri Bezinover, Kerstin Herzer, Knut M Nowak, Andreas Paul, Fuat H Saner
• Journal: Transplantation (Transplantation) Vol. 103 Issue 2 Pg. 381-386 (02 2019) ISSN: 1534-6080 [Electronic] United States
• PMID: 29944619 (Publication Type: Journal Article)

Chemical References

• Immunoglobulin M
• Vasoconstrictor Agents

Topics

• Adult
• Aged
• Female
• Humans
• Immunoglobulin M (therapeutic use)
• Liver Transplantation (adverse effects, mortality)
• Living Donors
• Male
• Middle Aged
• Retrospective Studies
• Shock (drug therapy)
• Transplantation, Homologous
• Vasoconstrictor Agents (therapeutic use)
• Vasoplegia (drug therapy)