Secondary antibody deficiency is associated with development of infection in kidney transplantation: Results of a multicenter study.

Autor: Sarmiento E; Clinical Immunology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Immunology Department, Universidad Complutense, Madrid, Spain.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain., Jimenez M; Clinical Immunology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Immunology Department, Universidad Complutense, Madrid, Spain.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain., di Natale M; Clinical Immunology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Immunology Department, Universidad Complutense, Madrid, Spain.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain., Rodriguez-Ferrero M; Nephrology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain., Anaya F; Nephrology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain., Lopez-Hoyos M; Immunology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.; Histocompatibility Testing Laboratory, Hospital Universitario Marqués de Valdecilla, Santander, Spain., Rodrigo E; Nephrology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain., Arias M; Nephrology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain., Perello M; Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain., Seron D; Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain., Karanovic B; Clinical Immunology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Immunology Department, Universidad Complutense, Madrid, Spain.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain., Ezzahouri I; Clinical Immunology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Immunology Department, Universidad Complutense, Madrid, Spain.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain., Mezzano S; Division of Nephrology, School of Medicine, Universidad Austral, Valdivia, Chile., Jaramillo M; Clinical Immunology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Immunology Department, Universidad Complutense, Madrid, Spain.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.; Medicine Institute, Universidad Austral, Valdivia, Chile., Calahorra L; Clinical Immunology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Immunology Department, Universidad Complutense, Madrid, Spain.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain., Alarcon A; Clinical Immunology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Immunology Department, Universidad Complutense, Madrid, Spain.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain., Navarro J; Clinical Immunology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Immunology Department, Universidad Complutense, Madrid, Spain.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain., Muñoz P; Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Carbone J; Clinical Immunology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Immunology Department, Universidad Complutense, Madrid, Spain.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Jazyk: angličtina
Zdroj: Transplant infectious disease : an official journal of the Transplantation Society [Transpl Infect Dis] 2021 Apr; Vol. 23 (2), pp. e13494. Date of Electronic Publication: 2020 Oct 27.
DOI: 10.1111/tid.13494
Abstrakt: Background: We performed a multicenter study to assess the association between secondary antibody deficiency (immunoglobulin G [IgG] hypogammaglobulinemia combined with low levels of specific antibodies) and development of infection in kidney transplantation.
Methods: We prospectively analyzed 250 adult kidney recipients at four centers. The assessment points were before transplantation and 7 and 30 days after transplantation. The immune parameters were as follows: IgG, IgA, and IgM and complement factors C3 and C4 tested by nephelometry; specific IgG antibodies to cytomegalovirus (CMV) and IgG and IgG2 antibodies to pneumococcal polysaccharide (anti-PPS) determined using enzyme-linked immunosorbent assay. The clinical follow-up period lasted 6 months. The clinical outcomes were CMV disease and recurrent bacterial infections requiring antimicrobial therapy.
Statistics: Multivariate logistic regression.
Results: At day 7, IgG hypogammaglobulinemia (IgG levels < 700 mg/dL) combined with low IgG anti-CMV antibody titers (defined as levels < 10 000 units) was present in 12% of kidney recipients. IgG hypogammaglobulinemia combined with low IgG anti-PPS antibody titers (defined as levels < 10 mg/dL) at 1 month after kidney transplantation were recorded in 16% of patients. At day 7 the combination of IgG hypogammaglobulinemia and low anti-CMV titers was independently associated with the development of CMV disease (odds ratio [OR], 6.95; 95% confidence interval [CI], 1.17-41.31; P = .033). At day 30 after transplantation, the combination of IgG < 700 mg/dL and IgG anti-PPS < 10 mg/dL, was independently associated with recurrent bacterial infection (OR, 5.942; 95% CI, 1.943-18.172; P = .002).
Conclusion: In a prospective multicenter study, early immunologic monitoring of secondary antibody deficiency proved useful for the identification of kidney recipients who developed severe infection.
(© 2020 Wiley Periodicals LLC.)
Databáze: MEDLINE
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