Abstract
After organ transplantation, gamma globulin and intravenous immunoglobulin enriched with IgM are most frequently used in septic shock as early immune-support. If the explanted organ is infected, the transplantation, as a life-saving operation, can be performed if there is no systemic inflammation and the patient receives IgM enriched immunoglobulin prophylaxis during surgery. The period after transplantation can be divided into three parts from the infection point of view: the first month after transplantation, the first sixth months and the following six months. Infections within the first month are basically related to the surgical procedure. Because of the immunosuppressive therapy, the opportunistic and fungal infections are more common during the first sixth months. After this period, the occurrence and the type of infections are similar to that of the non-transplant population except for pulmonary infections. The latter is two to three times more frequent. This is explained by the secondary hypogammaglobulinaemia (lower blood levels of IgM and IgG) which is caused by the steroids but most of mycophenolate mofetil by inhibition of the T and B lymphocyte proliferation. Septic shock develops with a continuing fall of IgM levels. Under these circumstances additional intravenous immunoglobulin therapy with IgM can be lifesaving. Besides, immunoglobulin concentrates with IgM may also be used in the case of viral infections without prophylaxis and/or without etiological therapy such as in the case of West Nile virus infection. As a result of the increase in antibiotic resistance, the application of immunotherapy, including immunoglobulins may become the mainstream in the treatment of septic shock.
Highlights
The immunoglobulin therapy started more than 100 years ago with the use of anti-diphtheria serum from horse and continued with the successful treatment of primary and secondary immunodeficiency with intravenous immunoglobulin (IVIG) products
The other option is the adjuvant treatment of transplanted patients, which is usually performed with the use of gamma globulin or intravenous immunoglobulin enriched with IgM
In severe sepsis and septic shock the use of early IgM-enriched immunoglobulins within the first 1–2 days is recommended
Summary
The immunoglobulin therapy started more than 100 years ago with the use of anti-diphtheria serum from horse and continued with the successful treatment of primary and secondary immunodeficiency with intravenous immunoglobulin (IVIG) products. Later on, this was augmented by the use of gamma globulin in the treatment of Guillan Barré syndrome, Kawasaki disease, chronic demyelinating polyneuropathy and different autoimmune diseases. The use of immunoglobulin in severe sepsis, septic shock is controversial [2, 3, 4], but a recent Cochrane analysis from 2013 highlighted the favorable effects of early treatment [5] (Table 1). The altered rate of immunoglobulin production showed effects on outcome in sepsis: IgG1,
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