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Roat E, Tosi M, Coloretti I, Bondi F, Chierego G, De Julis S, Talamonti M, Biagioni E, Busani S, Di Sandro S, Franceschini E, Guerrini GP, Meschiari M, Di Benedetto F, Mussini C, Girardis M. Perioperative Use of IgM-Enriched Immunoglobulins in Liver Transplantation Recipients at High Risk for Infections: A Preliminary Study. J Clin Med 2024; 13:4965. [PMID: 39201107 PMCID: PMC11355682 DOI: 10.3390/jcm13164965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Infections frequently occur after orthotopic liver transplantation (OLT) and are associated with increased mortality. In 2018, we introduced perioperative administration of intravenous immunoglobulin enriched in IgM as an optional therapy in recipients at a high risk of infection. This preliminary study evaluated whether this preparation reduced infections in the early post-transplantation period. Methods: Adult patients with a high risk of postoperative infections who underwent OLT between January 2014 and December 2021 in our center were included in the study. The primary outcome was the occurrence of new postoperative bacterial and fungal infections within the first 30 days after OLT. Results: Ninety recipients at a high risk of postoperative infections who underwent OLT were included, of whom 51 (57%) received IgM preparation. Patients treated and not treated with IgM were similar in terms of demographics, model of end-stage liver disease score, and risk factors for postoperative infections. The occurrence of new infections was lower (absolute risk reduction (ARR) 21.2%; p = 0.038) in patients who received IgM than in those who did not. Multivariate analysis adjusted for confounders (OR 0.348; p = 0.033) and propensity score-based matching analysis (ARR 21.2%, p = 0.067) confirmed an association between IgM preparation and lower occurrence of postoperative infections. The 90-day mortality rate was lower (ARR 13.4%, p = 0.018) in patients who received IgM preparation. Conclusions: In OLT recipients at high risk for infections, perioperative administration of an IgM-enriched preparation seems to reduce the development of new infections within the first 30 days after OLT.
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Affiliation(s)
- Erika Roat
- Anesthesia and Intensive Care Unit, University Hospital of Modena, University of Modena and Reggio Emilia, L.go del Pozzo 71, 41125 Modena, Italy; (E.R.); (M.T.); (I.C.); (F.B.); (G.C.); (S.D.J.); (M.T.); (E.B.); (S.B.)
| | - Martina Tosi
- Anesthesia and Intensive Care Unit, University Hospital of Modena, University of Modena and Reggio Emilia, L.go del Pozzo 71, 41125 Modena, Italy; (E.R.); (M.T.); (I.C.); (F.B.); (G.C.); (S.D.J.); (M.T.); (E.B.); (S.B.)
| | - Irene Coloretti
- Anesthesia and Intensive Care Unit, University Hospital of Modena, University of Modena and Reggio Emilia, L.go del Pozzo 71, 41125 Modena, Italy; (E.R.); (M.T.); (I.C.); (F.B.); (G.C.); (S.D.J.); (M.T.); (E.B.); (S.B.)
| | - Filippo Bondi
- Anesthesia and Intensive Care Unit, University Hospital of Modena, University of Modena and Reggio Emilia, L.go del Pozzo 71, 41125 Modena, Italy; (E.R.); (M.T.); (I.C.); (F.B.); (G.C.); (S.D.J.); (M.T.); (E.B.); (S.B.)
| | - Giovanni Chierego
- Anesthesia and Intensive Care Unit, University Hospital of Modena, University of Modena and Reggio Emilia, L.go del Pozzo 71, 41125 Modena, Italy; (E.R.); (M.T.); (I.C.); (F.B.); (G.C.); (S.D.J.); (M.T.); (E.B.); (S.B.)
| | - Stefano De Julis
- Anesthesia and Intensive Care Unit, University Hospital of Modena, University of Modena and Reggio Emilia, L.go del Pozzo 71, 41125 Modena, Italy; (E.R.); (M.T.); (I.C.); (F.B.); (G.C.); (S.D.J.); (M.T.); (E.B.); (S.B.)
| | - Marta Talamonti
- Anesthesia and Intensive Care Unit, University Hospital of Modena, University of Modena and Reggio Emilia, L.go del Pozzo 71, 41125 Modena, Italy; (E.R.); (M.T.); (I.C.); (F.B.); (G.C.); (S.D.J.); (M.T.); (E.B.); (S.B.)
| | - Emanuela Biagioni
- Anesthesia and Intensive Care Unit, University Hospital of Modena, University of Modena and Reggio Emilia, L.go del Pozzo 71, 41125 Modena, Italy; (E.R.); (M.T.); (I.C.); (F.B.); (G.C.); (S.D.J.); (M.T.); (E.B.); (S.B.)
| | - Stefano Busani
- Anesthesia and Intensive Care Unit, University Hospital of Modena, University of Modena and Reggio Emilia, L.go del Pozzo 71, 41125 Modena, Italy; (E.R.); (M.T.); (I.C.); (F.B.); (G.C.); (S.D.J.); (M.T.); (E.B.); (S.B.)
| | - Stefano Di Sandro
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena, University of Modena and Reggio Emilia, 41121 Modena, Italy; (S.D.S.); (G.P.G.); (F.D.B.)
| | - Erika Franceschini
- Infectious Disease Unit, University Hospital of Modena, University of Modena and Reggio Emilia, 41121 Modena, Italy; (E.F.); (M.M.); (C.M.)
| | - Gian Piero Guerrini
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena, University of Modena and Reggio Emilia, 41121 Modena, Italy; (S.D.S.); (G.P.G.); (F.D.B.)
| | - Marianna Meschiari
- Infectious Disease Unit, University Hospital of Modena, University of Modena and Reggio Emilia, 41121 Modena, Italy; (E.F.); (M.M.); (C.M.)
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena, University of Modena and Reggio Emilia, 41121 Modena, Italy; (S.D.S.); (G.P.G.); (F.D.B.)
| | - Cristina Mussini
- Infectious Disease Unit, University Hospital of Modena, University of Modena and Reggio Emilia, 41121 Modena, Italy; (E.F.); (M.M.); (C.M.)
| | - Massimo Girardis
- Anesthesia and Intensive Care Unit, University Hospital of Modena, University of Modena and Reggio Emilia, L.go del Pozzo 71, 41125 Modena, Italy; (E.R.); (M.T.); (I.C.); (F.B.); (G.C.); (S.D.J.); (M.T.); (E.B.); (S.B.)
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Otani IM, Lehman HK, Jongco AM, Tsao LR, Azar AE, Tarrant TK, Engel E, Walter JE, Truong TQ, Khan DA, Ballow M, Cunningham-Rundles C, Lu H, Kwan M, Barmettler S. Practical guidance for the diagnosis and management of secondary hypogammaglobulinemia: A Work Group Report of the AAAAI Primary Immunodeficiency and Altered Immune Response Committees. J Allergy Clin Immunol 2022; 149:1525-1560. [PMID: 35176351 DOI: 10.1016/j.jaci.2022.01.025] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/31/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022]
Abstract
Secondary hypogammaglobulinemia (SHG) is characterized by reduced immunoglobulin levels due to acquired causes of decreased antibody production or increased antibody loss. Clarification regarding whether the hypogammaglobulinemia is secondary or primary is important because this has implications for evaluation and management. Prior receipt of immunosuppressive medications and/or presence of conditions associated with SHG development, including protein loss syndromes, are histories that raise suspicion for SHG. In patients with these histories, a thorough investigation of potential etiologies of SHG reviewed in this report is needed to devise an effective treatment plan focused on removal of iatrogenic causes (eg, discontinuation of an offending drug) or treatment of the underlying condition (eg, management of nephrotic syndrome). When iatrogenic causes cannot be removed or underlying conditions cannot be reversed, therapeutic options are not clearly delineated but include heightened monitoring for clinical infections, supportive antimicrobials, and in some cases, immunoglobulin replacement therapy. This report serves to summarize the existing literature regarding immunosuppressive medications and populations (autoimmune, neurologic, hematologic/oncologic, pulmonary, posttransplant, protein-losing) associated with SHG and highlights key areas for future investigation.
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Affiliation(s)
- Iris M Otani
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, UCSF Medical Center, San Francisco, Calif.
| | - Heather K Lehman
- Division of Allergy, Immunology, and Rheumatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Artemio M Jongco
- Division of Allergy and Immunology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - Lulu R Tsao
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, UCSF Medical Center, San Francisco, Calif
| | - Antoine E Azar
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore
| | - Teresa K Tarrant
- Division of Rheumatology and Immunology, Duke University, Durham, NC
| | - Elissa Engel
- Division of Hematology and Oncology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Jolan E Walter
- Division of Allergy and Immunology, Johns Hopkins All Children's Hospital, St Petersburg, Fla; Division of Allergy and Immunology, Morsani College of Medicine, University of South Florida, Tampa; Division of Allergy and Immunology, Massachusetts General Hospital for Children, Boston
| | - Tho Q Truong
- Divisions of Rheumatology, Allergy and Clinical Immunology, National Jewish Health, Denver
| | - David A Khan
- Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas
| | - Mark Ballow
- Division of Allergy and Immunology, Morsani College of Medicine, Johns Hopkins All Children's Hospital, St Petersburg
| | | | - Huifang Lu
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, Houston
| | - Mildred Kwan
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Sara Barmettler
- Allergy and Immunology, Massachusetts General Hospital, Boston.
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