Perioperative Use of IgM-Enriched Immunoglobulins in Liver Transplantation Recipients at High Risk for Infections: A Preliminary Study
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
OLT | orthotopic liver transplantation |
IVIg | polyclonal standard IgG |
ICU | intensive care unit |
IgM | IgM-enriched polyclonal immunoglobulins product |
MELD | model of end stage liver disease |
ELSD | end stage liver disease |
ICU | intensive care unit |
Ig | immunoglobulins |
HGG | hypogammaglobulinemia |
MDR | multi drug resistant |
HCC | hepatocellular carcinoma |
HBV | hepatitis B virus |
HCV | hepatitis C virus |
LD | liver disease |
References
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Total (n = 90) | No IgM (n = 39) | IgM (n = 51) | p-Value | |
---|---|---|---|---|
Age (years; median-IQR) | 56 (50–63) | 57 (53–63) | 55 (50–63) | 0.194 |
Female (n, %) | 27 (30) | 11 (28.2) | 16 (31.4) | 0.744 |
Diabetes (n, %) | 23 (25.6%) | 10 (25.6%) | 13 (25.5%) | 0.987 |
MELD score (median-IQR) | 22 (12–29) | 22 (12–29) | 20 (12–29) | 0.625 |
Causes of ESLD (n, %) | ||||
Hepatocellular carcinoma | 20 (22.2) | 10 (25.6) | 10 (19.6) | 0.495 |
HBV-related | 10 (11.1) | 5 (12.8) | 5 (9.8) | 0.652 |
HCV-related | 21 (23.3) | 11 (28.2) | 10 (19.6) | 0.339 |
Alcoholoic | 38 (42.2) | 16 (41.0) | 22 (43.1) | 0.841 |
Other causes | 41 (45.6) | 14 (35.9) | 27 (52.9) | 0.128 |
Non -standard antibiotic prophylaxis (n, %) | 83 (92.2) | 34 (87.2) | 46 (90.2) | 0.118 |
Anti-fungal prophylaxis (n, %) | 39 (43.3) | 19 (48.7) | 20 (39.2) | 0.258 |
Risk Factors for post-operative infections (n, %) | ||||
Ongoing Infections | 37 (41.1) | 13 (33.3) | 24 (47.1) | 0.191 |
Infections 30 days before OLT | 53 (58.9) | 23 (59) | 30 (58.8) | 0.982 |
Colonization MDR 30 days before OLT | 59 (65.6) | 27 (69.2) | 32 (62.7) | 0.374 |
ICU admission 30 days before OLT | 18 (20) | 10 (25.6) | 8 (15.7) | 0.246 |
Total (n = 90) | No IgM (n = 39) | IgM (n = 51) | p-Value | |
---|---|---|---|---|
New Infections 30 days after-OLT (n, %) | 33 (36.7) | 19 (48.7) | 14 (27.5) | 0.038 |
New respiratory tract infections 30 days after-OLT (n, %) | 16 (17.8) | 8 (20.5) | 8 (15.7) | 0.123 |
New abdominal infections 30 days after-OLT (n, %) | 14 (15.6) | 9 (23) | 5 (9.8) | 0.140 |
New primary blood stream infections 30 days after-OLT (n, %) | 5 (5.6) | 4 (10.3) | 1 (2) | 0.089 |
New other infections 30 days after-OLT (n, %) | 4 (4.4) | 2 (5.1) | 2 (3.9) | 0.783 |
MDR infections 30 days after OLT (n, %) | 10 (11.1) | 6 (15.4) | 4 (7.8) | 0.208 |
New colonization by MDR 30 days after OLT (n, %) | 24 (26.7) | 12 (30.8) | 12 (23.5) | 0.442 |
New septic shock 30 days after-OLT (n, %) | 5 (5.6) | 3 (7.7) | 2 (3.9) | 0.421 |
ICU free days at day 30 after OLT (median, IQR) | 27 (24–28) | 26 (25–27) | 27 (24–28) | 0.231 |
New AKI requiring CRRT 30 days after-OLT (n, %) | 5 (5.6) | 2 (5.1) | 3 (5.9) | 0.900 |
Re-laparotomy 30 days after-OLT (n, %) | 11 (12.2) | 4 (10.3) | 7 (13.7) | 0.650 |
Hospital free days at day 90 (median, IQR) | 69 (56–77) | 71 (63–76) | 67 (55–77) | 0.503 |
Mortality at day 30 post OLT (n, %) | 1 (1.1) | 1 (2.6) | 0 (0) | 0.252 |
Mortality at day 90 post OLT (n, %) | 7 (7.8) | 6 (15.4) | 1 (2) | 0.018 |
No Infections Post-OLT (n = 57) | Infections Post-OLT (n = 33) | Unadjusted OR (95% CI); p-Value | Adjusted OR (95% CI); p-Value | |
---|---|---|---|---|
Age; (years; median, IQR) | 57 (51–63) | 56 (50–62) | 1.002 (0.958–1.048); 0.944 | |
Sex, female (n, %) | 19 (33.3) | 8 (24.2) | 0.640 (0.243–1.685); 0.384 | |
MELD score (median, IQR) | 18 (11–29) | 25 (12–31) | 1.054 (1.004–1.106); 0.034 | 1.034 (0.979–1.091); 0.229 |
Causes of ESLD (n, %) | ||||
Hepatocellular carcinoma | 11 (19.3) | 9 (27.3) | 1.568 (0.571–4.305); 0.381 | |
HBV-related | 6 (10.5) | 4 (12.1) | 1.172 (0.306–4.499); 0.817 | |
HCV-related | 15 (26.3) | 6 (18.2) | 0.622 (0.215–1.801); 0.379 | |
Alcoholic | 23 (40.4) | 15 (45.5) | 1.232 (0.518–2.928); 0.637 | |
Other causes | 26 (45.6) | 15 (45.5) | 0.994 (0.420–2.350); 0.988 | |
Risk Factors for infections (n, %) | ||||
Ongoing Infections | 22 (38.6) | 15 (45.5) | 1.326 (0.556–3.159); 0.524 | |
Infections 30 days before OLT | 32 (56.1) | 21 (63.6) | 1.367 (0.566–3.301); 0.486 | |
Colonization MDR 30 days before OLT | 39 (68.4) | 20 (60.6) | 0.808 (0.327–1.992); 0.643 | |
ICU admission 30 days before OLT | 6 (10.5) | 12 (36.4) | 4.857 (1.610–14.649); 0.003 | 3.496 (1.002–12.205); 0.050 |
IgM (n, %) | 37 (64.9) | 14 (42.4) | 0.378 (0.205–0.700); 0.002 | 0.348 (0.132–0.919); 0.033 |
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Roat, E.; Tosi, M.; Coloretti, I.; Bondi, F.; Chierego, G.; De Julis, S.; Talamonti, M.; Biagioni, E.; Busani, S.; Di Sandro, S.; et al. Perioperative Use of IgM-Enriched Immunoglobulins in Liver Transplantation Recipients at High Risk for Infections: A Preliminary Study. J. Clin. Med. 2024, 13, 4965. https://doi.org/10.3390/jcm13164965
Roat E, Tosi M, Coloretti I, Bondi F, Chierego G, De Julis S, Talamonti M, Biagioni E, Busani S, Di Sandro S, et al. Perioperative Use of IgM-Enriched Immunoglobulins in Liver Transplantation Recipients at High Risk for Infections: A Preliminary Study. Journal of Clinical Medicine. 2024; 13(16):4965. https://doi.org/10.3390/jcm13164965
Chicago/Turabian StyleRoat, Erika, Martina Tosi, Irene Coloretti, Filippo Bondi, Giovanni Chierego, Stefano De Julis, Marta Talamonti, Emanuela Biagioni, Stefano Busani, Stefano Di Sandro, and et al. 2024. "Perioperative Use of IgM-Enriched Immunoglobulins in Liver Transplantation Recipients at High Risk for Infections: A Preliminary Study" Journal of Clinical Medicine 13, no. 16: 4965. https://doi.org/10.3390/jcm13164965