Early intravenous immunoglobulin replacement in hypogammaglobulinemic heart transplant recipients: results of a clinical trial

Sarmiento, E.; Diez, P.; Arraya, Mauricio; Jaramillo, María; Calahorra, Leticia; Fernàndez-Yáñez, J.; Palomo, Jesús; Sousa, Iago; Hortal, Javier; Barrio, J; Alonso, Roberto; Muñóz, Patricia; Navarro, J.; Vicário, José L.; Fernández‐Cruz, Eduardo; Carbone, J.

doi:10.1111/tid.12610

Cited by 23 publications

(50 citation statements)

References 24 publications

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“…Risk of bias in RCTs was high in most cases due to lack of reporting on loss of patients during follow-up, blinding, and study compliance. 25 The same study also reported five episodes of CMV disease in the control group while there were no cases of CMV disease in the IVIG group (P = 0.016). 35 Diagrams of overall and study specific risk of bias Funnel plots could not be generated to assess the risk of publication bias due to inadequate studies for each outcome.…”

Section: Risk Of Bias Evaluationsmentioning

confidence: 80%

“…36 The study also reported that hypersensitivity reactions with IVIG were rare. 25 There was a significant risk reduction in severe bacterial infection in patients who had received IVIG but the sample size was small (only 25 patients). 39 However, this was not the primary outcome of interest for most of the studies that were included in our study, except for one heart transplant investigation.…”

Section: Liver Transplantation (N = 4; 3 Rct 303134 and 1 Retrospmentioning

confidence: 93%

“…In this category of studies, there was one study with low risk of bias. 25 One study reported low back pain in one patient during IVIG infusion and another developing tachypnea, but these events did not require discontinuation of IVIG administration. The prospective study reported on severe non-specified infection and severe bacterial infection.…”

Section: Risk Of Bias Evaluationsmentioning

confidence: 99%

“…36 Rate of infection was chosen as the primary outcome of our study as it was believed to be the most directly impacted by IVIG use in patients with primary antibody deficiency syndrome. 25 Therefore, there needs to be further investigations related to this outcome before any conclusions can be made about the effectiveness of IVIG in this context. 25 There was a significant risk reduction in severe bacterial infection in patients who had received IVIG but the sample size was small (only 25 patients).…”

Section: Liver Transplantation (N = 4; 3 Rct 303134 and 1 Retrospmentioning

confidence: 99%

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Clinical outcomes of polyvalent immunoglobulin use in solid organ transplant recipients: A systematic review and meta‐analysis – Part II: Non‐kidney transplant

Bourassa‐Blanchette

Patel

Knoll

et al. 2019

Clinical Transplantation

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Immunoglobulin (IG) is commonly used to desensitize and treat antibody-mediated rejection in solid organ transplant (SOT) recipients. The impact of IG on other outcomes such as infection, all-cause mortality, graft rejection, and graft loss is not clear.We conducted a similar systematic review and meta-analysis to our previously reported Part I excluding kidney transplant. A comprehensive literature review found 16 studies involving the following organ types: heart (6), lung (4), liver (4), and multiple organs (2). Meta-analysis could only be performed on mortality outcome in heart and lung studies due to inadequate data on other outcomes. There was a significant reduction in mortality ; 4 studies, n = 455) in heart transplant with hypogammaglobulinemia receiving IVIG vs no IVIG. Mortality in lung transplant recipients with hypogammaglobulinemia receiving IVIG was comparable to those of no hypogammaglobulinemia (OR 1.05 [0.49, 2.26]; 2 studies, n = 887). In summary, IVIG targeted prophylaxis may decrease mortality in heart transplant recipients as compared to those with hypogammaglobulinemia not receiving IVIG, or improve mortality to the equivalent level with those without hypogammaglobulinemia in lung transplant recipients, but there is a lack of data to support physicians in making decisions around using immunoglobulins in all SOT recipients for infection prophylaxis. K E Y W O R D Simmunoglobulin prophylaxis, meta-analysis, solid organ transplantation, systematic reviews, transplant complications

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Section: Risk Of Bias Evaluationsmentioning

confidence: 80%

Section: Liver Transplantation (N = 4; 3 Rct 303134 and 1 Retrospmentioning

confidence: 93%

Section: Risk Of Bias Evaluationsmentioning

confidence: 99%

Section: Liver Transplantation (N = 4; 3 Rct 303134 and 1 Retrospmentioning

confidence: 99%

See 2 more Smart Citations

Clinical outcomes of polyvalent immunoglobulin use in solid organ transplant recipients: A systematic review and meta‐analysis – Part II: Non‐kidney transplant

Bourassa‐Blanchette

Patel

Knoll

et al. 2019

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…Infusions with intravenous immunoglobulin and Octaplasma compensated for the patient’s decreased number of immunoglobulins and may have contributed to the reduced rate of infection. Previous studies have shown that prophylactic intravenous immunoglobulin replacement therapy can modulate hypogammaglobulinaemia and potentially decrease the incidence of severe infections 12. Unfortunately, immunoglobulin supplementation is costly.…”

Section: Discussionmentioning

confidence: 99%

Strategies to reduce line infections in a small child with homozygous familial hypercholesterolaemia who cannot yet receive LDL apheresis

et al. 2017

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Patients with homozygous familial hypercholesterolaemia are optimally treated with low-density lipoprotein apheresis. Young patients who do not meet a weight threshold (25 kg) receive regular plasmapheresis. This approach may remove excessive immunoglobulins and vascular access set-up can be challenging. We report the case of a 4 year-old child who exhibited repeated septic infections (5 in 6 months) and had recurrent access issues before two interventions were implemented: (1) the percutaneous central venous line was modified to two implanted paediatric ports, and (2) the patient started receiving two bags of Octaplasma at the end of each plasmapheresis treatment to account for the excessive loss of immunoglobulins. For the paediatric plasmapheresis access port, a 19-gauge Huber needle had to be used for the arterial port to prevent the collapse of the extension. These two simple changes have left the patient infection-free for 9 months.

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IgM‐enriched immunoglobulin as adjuvant therapy for heart transplant after infection of left ventricular assist devices

et al. 2022

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Patients undergoing heart transplantation (HTx) with active infection of left ventricular assist devices (LVAD) are at high risk for postoperative infections. Between 2021 and 2022, five (P1–P5) of a total of n = 44 patients underwent HTx in our department while suffering from LVAD infection. Postoperatively, patients received adjuvant IgM‐enriched human intravenous immunoglobulin (IGM‐IVIG), consisting of 76% IgG, 12% IgM, and 12% IgA as a novel approach to prevent infective complications. While in P1, P2, and P4, LVAD driveline infection was known before HTx; in P3 and P5, abscess of device pocket was found incidentally during HTx. After a single dose of IGM‐IVIG, all patients showed adequate rise in serum immunoglobulins. In the postoperative course, no patient developed infective complications. All patients were successfully discharged and in good condition at the last follow‐up. Therefore, IGM‐IVIG seems to be an effective adjuvant treatment for patients undergoing HTx with LVAD infections.

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Early intravenous immunoglobulin replacement in hypogammaglobulinemic heart transplant recipients: results of a clinical trial

Abstract: Data from this study demonstrate that prophylactic IVIG replacement therapy safely modulates HGG and specific antimicrobial antibodies. Our data also preliminarily suggest that IVIG replacement therapy might decrease the incidence of severe infection in heart recipients with HGG.

Cited by 23 publications

References 24 publications

Clinical outcomes of polyvalent immunoglobulin use in solid organ transplant recipients: A systematic review and meta‐analysis – Part II: Non‐kidney transplant

Clinical outcomes of polyvalent immunoglobulin use in solid organ transplant recipients: A systematic review and meta‐analysis – Part II: Non‐kidney transplant

Strategies to reduce line infections in a small child with homozygous familial hypercholesterolaemia who cannot yet receive LDL apheresis

IgM‐enriched immunoglobulin as adjuvant therapy for heart transplant after infection of left ventricular assist devices

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