Acquired hypogammaglobulinemia in HIV ‐positive subjects after liver transplantation

Abstract

Introduction As more solid organ transplantations are performed in patients infected with human immunodeficiency virus ( HIV ), post‐transplant complications in this population are becoming better defined. Methods Using serum samples from the Solid Organ Transplantation in HIV : Multi‐Site Study, we studied the epidemiology of acquired hypogammaglobulinemia ( HGG ) after liver transplantation ( LT ) in 79 HIV ‐infected individuals with a median CD 4 count at enrollment of 288 (interquartile range 200–423) cells/μL. Quantitative immunoglobulin G (IgG) levels before and after LT were measured, with moderate and severe HGG defined as IgG 350–500 mg/dL and <350 mg/dL, respectively. Incidence, risk factors, and associated outcomes of moderate or worse HGG were evaluated using K aplan– M eier estimator and proportional hazards ( PH ) models. Results The 1‐year cumulative incidence of moderate or worse HGG was 12% (95% confidence interval [ CI ]: 6–22%); no new cases were observed between years 1 and 2. In a multivariate PH model, higher pre‐transplant model for end‐stage liver disease score ( P = 0.04) and treated acute rejection ( P = 0.04) were both identified as significant predictors of moderate or worse HGG . There was a strong association of IgG levels <500 mg/dL with non‐opportunistic serious infection (hazard ratio [95% CI ]: 3.5 [1.1–10.6]; P = 0.03) and mortality (3.2 [1.1–9.4]; P = 0.04). These associations held after adjustment for important determinants of infection and survival among the entire cohort. Conclusion These results suggest that a proportion of HIV ‐positive LT recipients will develop clinically significant HGG after transplantation.