Ampliado el plazo de presentación de abstract hasta el día 24 de Octubre

 

31. INTRAVENOUS IMMUNOGLOBULIN IS ASSOCIATED WITH LOWER RATES OF RE-INFECTION IN SOLID ORGAN RECIPIENTS WITH SEVERE INFECTION AND SECONDARY ANTIBODY DEFICIENCY: PRELIMINARY RESULTS OF A RANDOMIZED CLINICAL TRIAL.

Carbone J, Montánchez J, Cifrian J, Laporta R, Ussetti P, Zatarain E, Salcedo M, Rodríguez M, Muñoz P, Bravo C, Fernández-Sabe N, González-Costello J, Segovia J, Gomez Bueno M, De Pablos A, Navarro J, Sarmiento E.

HOSPITAL GENERAL UNIVERSITARIO GREGORIO MARAÑÓN. MADRID. HOSPITAL UNIVERSITARIO MARQUÉS DE VALDECILLA. SANTANDER. HOSPITAL UNIVERSITARIO PUERTA DE HIERRO. MADRID.
HOSPITAL UNIVERSITARIO VALLE DE HEBRÓN. BARCELONA. HOSPITAL UNIVERSITARIO DE BELLVITGE. BARCELONA. HOSPITAL UNIVERSITARIO 12 DE OCTUBRE. MADRID.

 

ESPECIALIDAD: Inmunología Clínica, Cardiología, Neumología, Nefrología, Medicina del Aparato Digestivo, Microbiología y Enfermedades Infecciosas.

 

Introducción: Severe infection is still a leading cause of death in solid organ transplantation. Secondary antibody deficiency after transplantation is a risk factor for development of severe infection.

 

Objetivos: In a multicenter randomized clinical trial we evaluated the efficacy and safety of an intravenous immunoglobulin (IVIG) protocol to decrease the rate of re-infection in solid organ recipients with severe infections and secondary antibody deficiency.

 

Metodología: Adult patients (Heart, Lung, Kidney or Liver Recipients) with post transplant severe infections and secondary antibody deficiency (IgG levels < 600 mg/dL at the time of the infectious complication) were included. IVIG protocol: Two doses of 15 grams followed by other 3 doses of 20 grams of a 5% IVIG product. 36 patients were randomized to receive IVIG in combination with conventional antimicrobial therapy (n=17) or conventional antimicrobial therapy alone (n=19). At the time of this report 33 patients were analysed. Distinct specific antibodies were tested at the time of inclusion in the clinical trial and at the time of final visit (visit 7 at 30-45 days after last IVIG dose or similar time in no-IVIG patients) in a subgroup of patients to assess the kinetics of humoral immunity reconstitution.

 

Resultados: The primary outcome measure (rate of re-infection) was significantly lower in patients randomized to receive IVIG as compared with patients receiving only conventional antimicrobial therapy (37.5 vs 76.5%, chi-square test, p=0.024). Time to reach normal IgG (IgG > 750 mg/dL) was shorter in IVIG group (55±44 vs 93±42 days, p=0.06). Significantly higher levels of specific anti-cytomegalovirus, anti-clostridium difficile toxins A and B was demonstrated at visit 7 in patients who received IVIG as compared with patients that were treated with antimicrobial therapy alone.

 

Conclusiones: In a randomized clinical trial we have preliminarily demonstrated that IVIG is associated with a lower rate of re-infection in solid organ transplantation with severe infection and secondary antibody deficiency. IVIG is able to reconstitute humoral immunity in these patients.    

 

 

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