Original Research
Saturday, October 12, 2024
11:30 AM–01:00 PM
Abstract
Introduction:
Hypogammaglobulinemia is a common complication that can increase infection risk after lung transplant, therefore subcutaneous or intravenous immune globulin (IVIG) replacement is recommended for solid organ transplant recipients with hypogammaglobulinemia. However, current use patterns of IVIG in lung transplant have not been well described in real world clinical practice.
Research Question or Hypothesis:
What are the hypogammaglobulinemia monitoring patterns, incidence rates, risk factors, and IVIG treatment patterns within 1 year after lung transplant?
Study Design:
Retrospective, single-center, descriptive study
Methods:
This study included adult patients who received a lung transplant at a quaternary care hospital from 01/2018 until 03/2021. Patients who received multiple simultaneous transplanted organs were excluded. The primary outcome was the indication of IVIG doses administered during the first year after lung transplant. Descriptive statistics and multivariable logistic regression modeling were performed. Statistical significance was set as p<0.05.
Results:
Among 198 lung transplant recipients included, IgG levels were monitored 5 times on average during the first year following transplant. Hypogammaglobulinemia (IgG<700 mg/dL) occurred in 177 (89%) patients, and severe hypogammaglobulinemia (IgG<400 mg/dL) occurred in 88 (44%) patients. A total of 166 (84%) patients received IVIG during the first year following lung transplant for the following indications: hypogammaglobulinemia without an infection in 81 (41%) patients, hypogammaglobulinemia with an infection in 95 (48%), donor-specific antibodies in 71 (36%), and antibody-mediated rejection in 28 (14%). Risk factors significantly associated with severe hypogammaglobulinemia included: underlying obstructive lung disease (adjusted odds ratio, aOR=3.6; p<0.001), baseline immunodeficiency due to corticosteroids (aOR=5.9; p=0.001), IgG administration within 1 year before transplant (aOR=11.0; p=0.004), and higher body mass index (aOR=1.1; p=0.045).
Conclusion:
The use of IVIG for hypogammaglobulinemia with or without an infection was common in this quaternary care hospital. Additional studies are needed to evaluate the economic and clinical outcomes of IVIG for hypogammaglobulinemia forinfection prevention among high-risk patients following lung transplant.
Presenting Author
Phuong Duong PharmD, MBA
Oregon State UniversityAuthors
Ahmad Goodarzi MD
Houston Methodist Hospital
Edward Graviss PhD, MPH
Houston Methodist Research Institute
Howard Huang MD
Houston Methodist Hospital
Navjot Kaur MS, PharmD
Houston Methodist Hospital
Jill Krisl PharmD
Houston Methodist Hospital
Linda Moore PhD
Houston Methodist Hospital
Duc Nguyen MD, PhD
Baylor College of Medicine
Taylor Pasley PharmD
Houston Methodist Hospital
Elsie Rizk PharmD
Houston Methodist Hospital
Simon Yau MD
Houston Methodist Hospital
J. Georges Youssef MD
Houston Methodist Hospital