PURPOSE: Hypogammaglobulinemia (HGG) in pediatric lung transplant patients has not been described. The purpose of this study is to define incidence, risk-factors, and outcomes of HGG in the first year after pediatric lung transplantation for immunoglobulin (Ig) classes G, A, and M.
METHODS: A retrospective chart review of all lung transplant recipients transplanted at a single pediatric center over a 5 year period was performed. All Ig levels drawn in the first post-transplant year were recorded. Potential risk factors including age, race, sex, and diagnosis leading to transplant were examined. Outcomes including hospital days, infections requiring hospitalization, viremia, and fungal recovery from bronchoalveolar lavage for the first post-transplant year were recorded. HGG was defined as an average Ig level below normal age range for each class. Kruskal-Wallis test and Spearman's correlation determined statistical significance.
RESULTS: Fifty-one charts were reviewed. Post-transplant IgG, IgA, and IgM levels were available for 32, 31, and 30 patients respectively. HGG was present in 48.8%, 12.2% and 17.1% of all patients for IgG, IgA, and IgM respectively. Mean (±SD) post-transplant IgG, IgA and IgM levels were 439.9 ± 201.3, 82.3 ± 50.2, and 75.2 ± 41.4 mg/dl respectively. Patients with IgG HGG were older than those with normal IgG levels (14.3 ± 3.8 vs. 9.2± 5.4 years; p <0.01). IgA and IgM HGG were associated with invasive aspergillosis (p<0.01 and p = 0.05, respectively). IgG levels inversely correlated with numbers of bacterial infections requiring hospitalization (p<0.01). IgM levels inversely correlated with hospital days (p<0.05).
CONCLUSION: IgG HGG is a frequent complication following lung transplantation in children. Older children seem more prone to develop IgG HGG. IgA and IgM HGG are associated with invasive aspergillosis. IgG and IgM levels are inversely related to numbers of bacterial infections and hospital days, respectively, in the first year following lung transplant.
CLINICAL IMPLICATIONS: A prospective study is warranted to thoroughly evaluate the incidence and outcome of HGG after pediatric lung transplantation. Immunoglobulin levels should be routinely monitored after pediatric lung transplantation.
DISCLOSURE: John Robertson, No Financial Disclosure Information; No Product/Research Disclosure Information