The association of IgA deficiency but not IgG or IgM deficiency with a reduced patient and graft survival following liver transplantation.
The association of IgA deficiency but not IgG or IgM deficiency with a reduced patient and graft survival following liver transplantation.
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IgA 缺乏而非 IgG 或 IgM 缺乏与肝移植后患者和移植物存活率降低有关。
DOI：
10.1097/00007890-199208000-00015
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发表时间：
1992
期刊：
影响因子：
6.2
通讯作者：
Gordon,R
中科院分区：
文献类型：
--
作者：
VanThiel,DH;Finkel,R;Friedlander,L;Gavaler,JS;Wright,HI;Gordon,R
实体器官同种异体移植的受体需要终身免疫抑制，以防止移植物排斥反应和维持移植物功能。一般来说，这种免疫抑制极大地损害细胞免疫系统，因为这种水平的免疫系统主要负责自我和非自我识别。当移植给予具有预先存在的体液免疫缺陷的个体时，同种异体移植在患者和移植物存活方面的后果尚未报道，所述体液免疫缺陷的特征在于一种或多种主要IG类的血清水平的缺乏。从1981年2月1日至1990年12月31日，共有43例1种或多种IG缺乏的成人患者在该机构接受了ABO匹配的肝移植。该样本占在此期间移植的1684名成人总数的2.5%。这43例肝移植受者可根据是否存在IgG、IgM或伊加缺乏分为3个主要组。IgG缺乏定义为水平< 50 mg/dl。与IgG和IgM缺陷组相比，IgA缺陷组的患者和移植物存活率显著降低（分别为P< 0.04和P< 0.009）。后两组在这两个相同的终点上与无IG缺乏的对照组没有差异。IgA缺乏组的主要死亡原因是败血症和机会性感染。IgA缺乏组中三分之一的死亡发生在围手术期（前30天），而超过50%的死亡发生在前3个月内，所有死亡都发生在第一年之前。基于这些数据，可以得出以下结论：（1）血清伊加缺乏而不是IgG或IgM缺乏与OLTx后死亡和移植物丢失率增加相关;（2）这些死亡中的大多数是由于败血症或机会性感染;（3）大多数死亡发生在早期。这些数据表明，认识到缺乏伊加的器官移植前，需要细致的注意，以预防感染的围手术期，如果患者和移植物的存活率，这些患者要得到改善。
: Recipients of solid organ allografts require lifelong immunosuppression in order to prevent graft rejection and to maintain graft function. In general, such immunosuppression greatly impairs the cellular immune system, as this level of the immune system is principally responsible for self and non-self recognition. The consequences of allograft transplantation in terms of patient and graft survival when transplants are given to individuals who have a preexisting humoral immune deficiency characterized by a deficiency of the serum levels of one or more of the major Ig classes have not yet been reported. From February 1, 1981 through December 31, 1990, a total of 43 adult patients with a deficiency of 1 or more Ig classes received a ABO-matched liver allograft at this institution. This sample represents 2.5% of a total of 1684 adults transplanted during this interval. These 43 liver graft recipients could be divided into 3 major groups based upon the presence of an IgG, IgM, or IgA deficiency. IgG deficiencies were defined as levels< 50 mg/dl. Patient and graft survival for the IgA-deficient group was significantly reduced (P< 0.04 and P< 0.009, respectively) compared with both the IgG-and IgM-deficient groups. The latter two groups did not differ from controls without an Ig deficiency for these same two endpoints. The major causes of death in the IgA-deficient group were sepsis and opportunistic infection. A third of the deaths in the IgA-deficient group occurred in the perioperative period (first 30 days) while greater than 50% of the deaths occurred within the first 3 months, and all deaths occurred before the first year. Based upon these data, the following conclusions can be made:(1) serum IgA deficiency but not IgG or IgM deficiency is associated with an increased post-OLTx death and graft loss rate;(2) the majority of these deaths are due to sepsis or an opportunistic infection; and (3) most of the deaths occur early. These data suggest that recognition of a deficiency of IgA prior to organ grafting necessitates meticulous attention to the prevention of infection in the immediate perioperative period if patient and graft survival of these patients is to be improved.