(367) - Hypogammaglobulinemia After Lung Transplantation Increases Risk of Recurrent Pneumonia

Abstract

Immunosuppressive therapies have led to vast improvements in survival in lung transplant (LT) recipients but these therapies can lead to hypogammaglobulinemia (HGG). To assess the impact of HGG on transplant outcomes, we reviewed one year findings from a prospective observational study examining the relationship of HGG to incidence of pneumonia, antibiotic use, presence of rejection, and steroid use. This is a single center study of LT recipients at the University of Pittsburgh Medical Center. IgG levels were measured pre-transplant, at time of transplant and at 3, 6, and 12 months post-transplant and related to incidence of pneumonia, antibiotic use, presence of rejection, and steroid use. Analysis was performed using non-parametric tests. 133 LT recipients were evaluated. Post-transplant subjects receiving Basiliximab had lower IgG levels at 3 and 6 months than those induced with Alemtuzamab, but those differences were absent at one year after transplant (p=0.2). In subjects who had one or more incidence of pneumonia, there was a negative correlation between IgG level and the number of pneumonias (Spearman’s rho= -0.31, p=0.05). In addition, one-year mortality was associated with lower IgG levels at 3 months post-transplant (p=0.04). There was no relationship between IgG levels and the number of courses of antibiotics, CMV status, steroid use, or presence of rejection. Our results suggest that LT recipients with HGG are at risk for developing recurrent pneumonias and increased mortality at 1 year. Additional analyses to better characterize these patients and to evaluate the efficacy of IgG replacement therapy for prevention of pneumonia and improvement in survival will be needed to further define the clinical importance and treatment of HGG in lung transplant recipients.