Immunoglobulin Levels and Occurrence of Infections After Lung Transplantation and Impact of IgG Replacement
Immunoglobulin Levels and Occurrence of Infections After Lung Transplantation and Impact of IgG Replacement
Immunosuppressive therapies have led to remarkable improvements in survival in lung
 transplantation (LT) patients. However, one important adverse effect of these therapies has
 been the increasing emergence of hypogammaglobulinemia (HGG) which has been previously seen
 mostly in patients with primary immunodeficiency (PID).

 The goal of treatment of HGG in PID has been to maintain the trough IgG level above 500 mg/dl
 which might provide better protection against infections than do lower IgG serum
 concentrations. Although IgG therapy is of substantial benefit, the doses and trough levels
 of IgG that are optimal are not yet clearly established. The impact of high versus low IgG
 dosing on the frequency and severity of infections and rejection has not been studied before
 in LT patients with HGG. The specific aims for this study are to compare the incidence of
 infections in lung transplant recipients receiving higher versus lower dose of SQ IgG and to
 compare the incidence of infections in lung transplant recipients with mild
 hypogammaglobulinemia versus normal IgG levels. This study will be a single center study of
 all lung transplant recipients, age 18 years or older, at the University of Pittsburgh
 Medical Center (UPMC), with a randomized treatment arm and an observational arm.

 The hypotheses for the research study are:

 -  Therapy with IV or SQ IgG is of substantial benefit in reducing the number of infections
 in lung transplant recipients with severe hypogammaglobulinemia (IgG < 500)

 -  A higher dose of SQ IgG, with subsequent higher trough IgG levels, may have a higher
 impact on the frequency and severity of infections and rejection episodes, compared to a
 lower dose of SQ IgG, with subsequent lower IgG trough levels

 -  Lung transplant recipients with mild hypogammaglobulinemia ( IgG= 500-750) have a higher
 incidence of infections compared to patients with normal IgG levels
Inclusion Criteria:

 -  adult recipients of lung transplantation at the University of Pittsburgh Medical
 Center, who are able to provide written informed consent prior to transplantation or
 on the day of lung transplant surgery.

 Exclusion Criteria:

 -  age less than 18 years-old

 -  history of anaphylaxis to IVIG

 -  subjects already on IV or SQ IgG treatment