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Acquired hypogammaglobulinemia in HIV-positive subjects after liver transplantation.
Transpl Infect Dis. 2013 Dec; 15(6):581-7.TI

Abstract

INTRODUCTION

As more solid organ transplantations are performed in patients infected with human immunodeficiency virus (HIV), post-transplant complications in this population are becoming better defined.

METHODS

Using serum samples from the Solid Organ Transplantation in HIV: Multi-Site Study, we studied the epidemiology of acquired hypogammaglobulinemia (HGG) after liver transplantation (LT) in 79 HIV-infected individuals with a median CD4 count at enrollment of 288 (interquartile range 200-423) cells/μL. Quantitative immunoglobulin G (IgG) levels before and after LT were measured, with moderate and severe HGG defined as IgG 350-500 mg/dL and <350 mg/dL, respectively. Incidence, risk factors, and associated outcomes of moderate or worse HGG were evaluated using Kaplan-Meier estimator and proportional hazards (PH) models.

RESULTS

The 1-year cumulative incidence of moderate or worse HGG was 12% (95% confidence interval [CI]: 6-22%); no new cases were observed between years 1 and 2. In a multivariate PH model, higher pre-transplant model for end-stage liver disease score (P = 0.04) and treated acute rejection (P = 0.04) were both identified as significant predictors of moderate or worse HGG. There was a strong association of IgG levels <500 mg/dL with non-opportunistic serious infection (hazard ratio [95% CI]: 3.5 [1.1-10.6]; P = 0.03) and mortality (3.2 [1.1-9.4]; P = 0.04). These associations held after adjustment for important determinants of infection and survival among the entire cohort.

CONCLUSION

These results suggest that a proportion of HIV-positive LT recipients will develop clinically significant HGG after transplantation.

Authors+Show Affiliations

Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

24103022

Citation

Gregg, K S., et al. "Acquired Hypogammaglobulinemia in HIV-positive Subjects After Liver Transplantation." Transplant Infectious Disease : an Official Journal of the Transplantation Society, vol. 15, no. 6, 2013, pp. 581-7.
Gregg KS, Barin B, Pitrak D, et al. Acquired hypogammaglobulinemia in HIV-positive subjects after liver transplantation. Transpl Infect Dis. 2013;15(6):581-7.
Gregg, K. S., Barin, B., Pitrak, D., Ramaprasad, C., & Pursell, K. (2013). Acquired hypogammaglobulinemia in HIV-positive subjects after liver transplantation. Transplant Infectious Disease : an Official Journal of the Transplantation Society, 15(6), 581-7. https://doi.org/10.1111/tid.12139
Gregg KS, et al. Acquired Hypogammaglobulinemia in HIV-positive Subjects After Liver Transplantation. Transpl Infect Dis. 2013;15(6):581-7. PubMed PMID: 24103022.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acquired hypogammaglobulinemia in HIV-positive subjects after liver transplantation. AU - Gregg,K S, AU - Barin,B, AU - Pitrak,D, AU - Ramaprasad,C, AU - Pursell,K, Y1 - 2013/09/18/ PY - 2012/08/01/received PY - 2013/01/29/revised PY - 2013/04/02/revised PY - 2013/04/09/accepted PY - 2013/10/10/entrez PY - 2013/10/10/pubmed PY - 2014/8/5/medline KW - HIV KW - hypogammaglobulinemia KW - infection KW - liver transplantation KW - mortality SP - 581 EP - 7 JF - Transplant infectious disease : an official journal of the Transplantation Society JO - Transpl Infect Dis VL - 15 IS - 6 N2 - INTRODUCTION: As more solid organ transplantations are performed in patients infected with human immunodeficiency virus (HIV), post-transplant complications in this population are becoming better defined. METHODS: Using serum samples from the Solid Organ Transplantation in HIV: Multi-Site Study, we studied the epidemiology of acquired hypogammaglobulinemia (HGG) after liver transplantation (LT) in 79 HIV-infected individuals with a median CD4 count at enrollment of 288 (interquartile range 200-423) cells/μL. Quantitative immunoglobulin G (IgG) levels before and after LT were measured, with moderate and severe HGG defined as IgG 350-500 mg/dL and <350 mg/dL, respectively. Incidence, risk factors, and associated outcomes of moderate or worse HGG were evaluated using Kaplan-Meier estimator and proportional hazards (PH) models. RESULTS: The 1-year cumulative incidence of moderate or worse HGG was 12% (95% confidence interval [CI]: 6-22%); no new cases were observed between years 1 and 2. In a multivariate PH model, higher pre-transplant model for end-stage liver disease score (P = 0.04) and treated acute rejection (P = 0.04) were both identified as significant predictors of moderate or worse HGG. There was a strong association of IgG levels <500 mg/dL with non-opportunistic serious infection (hazard ratio [95% CI]: 3.5 [1.1-10.6]; P = 0.03) and mortality (3.2 [1.1-9.4]; P = 0.04). These associations held after adjustment for important determinants of infection and survival among the entire cohort. CONCLUSION: These results suggest that a proportion of HIV-positive LT recipients will develop clinically significant HGG after transplantation. SN - 1399-3062 UR - https://www.unboundmedicine.com/medline/citation/24103022/Acquired_hypogammaglobulinemia_in_HIV_positive_subjects_after_liver_transplantation_ L2 - https://doi.org/10.1111/tid.12139 DB - PRIME DP - Unbound Medicine ER -