Hypogammaglobulinemia in lung transplant candidates

Introduction: Infections are the main cause of morbi-mortality in lung transplant recipients (LT). The hypogammaglobulinemia (HGG) after lung transplantation has been related to an increased frequency and severity of these infections. Objective: to assess the incidence and severity of HGG in LT candidates. Material and methods: Prospectively, from January 2014 until September 2015 a determination of serum globulin (SGG) was performed (IgG, IgM, IgA) on all LT candidates and their medical records were reviewed. We considered normal IgG levels > 700 mg/dl; mild HGG IgG 600-700mg/dl; moderate HGG IgG 400-600mg/dl and severe HGG IgG> 400 ml/ dl. Results: There were 99 LT candidates. 63 were male (63.6%) with a mean age of 54.1 years (range 27-66). The predominant lung diseases were chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) with 45.4% both. 18 patients (18.1%) had HGG (IgG): 2/18 patients (11.1%) had mild HGG; 12/18 (66.6%) moderate HGG and 4/18 (22.2%) severe HGG. 4 of these patients had a combined form of HGG (IgG and IgM). Thirteen patients with HGG were COPD (13/18, 72.2%): mild HGG 1/13, moderate HGG 8/13 and severe HGG 4/13. Four patients with ILD had HGG, one mild and three moderate. During the study 5/18 patients (27.7%) with HGG were transplanted. Two of them received replacement therapy while were in active list; only one of them had improved GGS levels without reaching normal level Conclusions: 18/99 (18.1%) LT candidates had HGG which was moderate-severe in the most cases 16/18 (88%). The COPD patients had the highest prevalence of HGG 13/18 (72.2%) (p = 0.012), being in 12/13 patients moderate-severe type.