1667. What is the impact of severe hypogammaglobulinemia on the risk of infections within the first year after solid organ transplantation? A Meta-analysis
Session: Poster Abstract Session: Pre-emptive Therapy in Transplantation and Immunocompromised Hosts
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • severe hypogammaglobulinemia.pdf (189.6 kB)
  • Background: The aim of the study was to determine the rate of severe hypogammaglobulinemia (IgG<400mg/dl) and its impact on different infections during the first year post-transplantation.

    Methods: All studies that evaluated severe hypogammaglobulinemia and post-transplant infections were included. The data was pooled using the DerSimonian and Laird random-effects model. I2was used to assess statistical heterogeneity. When comparing two groups, binary outcomes results were expressed as odds ratio, and continuous outcomes results as standardized mean difference.

    Results: Within first post-transplant year, the overall rate of hypogammaglobulinemia (IgG<700mg/dl) (1482 patients, 16 studies) was 45% (95%CI:0.34-0.55) and severe hypogammaglobulinemia (669 patients, 8 studies) was 15% (0.08-0.22). The odds of all infections for patients with severe hypogammaglobulinemia (2 studies, 267 patients) was 2.46 (95%CI:1.22-4.93;p=0.01) times higher than the odds of infections for patients with IgG>400mg/dl, and 3.73 (1.11-2.49;p=0.03) times higher than the odds of infections for patients with IgG>700mg/dl. The impact of severe hypogammaglobulinemia on different infections, rejection and mortality rates during the first post-transplant year are presented in the table:

     

    IgG<400mg/dl vs. IgG>400mg/dl

    No. of studies (patients)

    OR(95%CI)

    p-value

    I2

    Respiratory infections

    2(257)

    4.83(1.66-14.05)

    0.004

    0%

    CMV infections

    4(435)

    2.40(1.16-4.97)

    0.02

    26.66%

    Aspergillus infections

    2(124)

    8.19(2.38-28.21)

    0.0009

    17.02%

    Other fungal infections

    2(124)

    3.69(1.11-12.33)

    0.03

    0%

    Rejection

    2(257)

    1.43(0.52-3.92)

    0.48

    0%

    1-year mortality

    2(124)

    21.91(2.49-192.55)

    0.005

    0%

    Conclusion: Severe hypogammaglobulinemia during the first year after solid organ transplantation significantly increases the risk of CMV, fungal and respiratory infections, and the one-year mortality, with no impact on rejection rates. Monitoring IgG levels after solid organ transplantation might identify patients at high risk for infections.

    Diana F. Florescu, MD, Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, Uriel Sandkovsky, MD, FACP, Internal Medicine - Inf. Diseases, University Of Nebraska Medical Center, Omaha, NE, Fang Qiu, PhD, Biostatistics Department, Nebraska Medical Center, Omaha, NE, Cynthia Schmidt, MD, MLS, University of Nebraska Medical Center, Omaha, NE and Andre C. Kalil, MD, MPH, Internal Med., Univ. of Nebraska Med. Ctr., Omaha, NE

    Disclosures:

    D. F. Florescu, Behring: Consultant and Investigator, Consulting fee, Research grant and Research support
    Chimerix: Consultant and Grant Investigator, Consulting fee and Research grant

    U. Sandkovsky, Behring: Grant Investigator, Research support

    F. Qiu, Behring: Grant Investigator, Research grant

    C. Schmidt, None

    A. C. Kalil, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.