期刊
JOURNAL OF HEART AND LUNG TRANSPLANTATION
卷 36, 期 5, 页码 529-539出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.healun.2016.10.004
关键词
complement; heart transplantation; hypogammaglobulinemia; infection; risk factors
资金
- Fondo de Investigacion Sanitaria (Instituto de Salud Carlos III, Ministry of Economy and Competitiveness), Madrid, Spain [FIS 081430, FIS 1101323, FIS 1501472]
- European regional development funds, A Way of Making Europe, from the European Union
- Grifols (Barcelona, Spain)
- Instituto de Salud Carlos III, Ministry of Economy and Competitiveness
- Grifols, Inc. (Los Angeles, CA)
- CSL Behring (Barcelona, Spain)
BACKGROUND: New biomarkers are necessary to improve detection of the risk of infection in heart transplantation. We performed a multicenter study to evaluate humoral immunity profiles that could better enable us to identify heart recipients at risk of severe infections. METHODS: We prospectively analyzed 170 adult heart recipients at 8 centers in Spain. Study points were before transplantation and 7 and 30 days after transplantation. Immune parameters included IgG, IgM, IgA and complement factors C3 and C4, and titers of specific antibody to pneumococcal polysaccharide antigens (anti-PPS) and to cytomegalovirus (CMV). To evaluate potential immunologic mechanisms leading to IgG hypogammaglobulinemia, before heart transplantation we assessed serum B-cell activating factor (BAFF) levels using enzyme-linked immunoassay. The clinical follow-up period lasted 6 months. Clinical outcome was need for intravenous anti-microbials for therapy of infection. RESULTS: During follow-up, 53 patients (31.2%) developed at least 1 severe infection. We confirmed that IgG hypogammaglobulinemia at Day 7 (defined as IgG <600 mg/dl) is a risk factor for infection in general, bacterial infections in particular, and CMV disease. At Day 7 after transplantation, the combination of IgG <600 mg/dl + C3 <80 mg/dl was more strongly associated with the outcome (adjusted odds ratio 7.40; 95% confidence interval 1.48 to 37.03; p = 0.014). We found that quantification of anti-CMV antibody titers and lower anti-PPS antibody concentrations were independent predictors of CMV disease and bacterial infections, respectively. Higher pre-transplant BAFF levels were a risk factor of acute cellular rejection. CONCLUSION: Early immunologic monitoring of humoral immunity profiles proved useful for the identification of heart recipients who are at risk of severe infection. (C) 2017 International Society for Heart and Lung Transplantation. All rights reserved.
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