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Master Thesis

Non-specific immunoglobulin replacement in lung transplantation recipients with hypogammaglobulinemia: a cohort study taking into account propensity score and immortal time bias

Abstract : Background: After lung transplantation (LT), immunoglobulins G (IgG) plasma concentrations <6 g/L are common and correlate with an increased risk of Chronic Lung Allograft Dysfunction (CLAD) and a poorer survival. Methods: We conducted an open substitution intervention with nonspecific intra venous Ig (IVIg), in 54 patients with IgG plasma <6 g/L post LT out of 84 consecutive recipients since 1998 who survived more than 3 months. Results: Both substituted (S) and non-substituted (NS) groups had similar donor/recipient characteristics and events over a median follow-up of 2.8 years [Q1-Q3: 1.4-5.7]. IVIg substitution started 3.5 months [0.5-9.4] after transplantation and lasted 4.5 months after [1.0-17.7], mean cumulative dose was 52.8±47.7g. In multivariate Cox regression model, hypogammaglobulinemic patients who were substituted with IVIg had actually a 5-year survival, (hazard ratio (HR): 0.63 [95% CI: 0.26-1.49], p=0.29) and CLAD-free 5-year survival (HR: 0.51 [95%CI: 0.15-1.67], p=0.27) really close to non-hypogammaglobulinemic and non-substituted patients. Complementary analysis using propensity score and time-dependent analysis showed that survival and CLAD-free survival were not different in both groups. Conclusion: IVIg post LT achieved similar survival and CLAD-free survival in recipients with hypogammaglobulinemia as compared to those with normal IgG plasmatic rate. A randomized control is required to confirm benefic effects of IVIg and disentangle mechanisms including protection from infections, acute cellular and humoral rejections in patients with hypogammaglobulinemia after LT.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01116612
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Submitted on : Friday, February 13, 2015 - 5:05:59 PM
Last modification on : Tuesday, May 11, 2021 - 11:36:17 AM
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Johanna Claustre. Non-specific immunoglobulin replacement in lung transplantation recipients with hypogammaglobulinemia: a cohort study taking into account propensity score and immortal time bias. Human health and pathology. 2015. ⟨dumas-01116612⟩

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