Hypogammaglobulinemia in the early period after liver transplantation in children

Data, on the kinetic and serum levels of immunoglobulins in the immediate post-liver transplantation (LTx) period, are sparse with existing studies limited to adults or case reports of children. The aim of this study is to describe the phenomenon of hypogammaglobulinemia (HGG) in the immediate post-transplantation period among children undergoing LTx. A retrospective 10-yr chart review was conducted of all children who underwent LTx at a fourth-level pediatric medical center. Fifty-seven, of the 76 children who underwent LTx, were included in the study. Seventeen (29.8%) (mean age, 6.8 +/- 5.2yr) had HGG (11-IgG, 1-IgG+IgA, 1-IgG+IgM, 4-IgG+IgA+IgM), detected at 2 to 25d after transplantation. Abdominal fluid was drained for 5 to 42d; the amount drained until detection of HGG measured 27-668mL/kg. HGG was associated with increased infection rate 0.9 episodes/patient vs. 0.17 episodes/patient (p<0.01) in children without detected HGG. In conclusion, HGG is not rare in the immediate post-LTx period in children, and it may place patients at increased risk of infection. Further studies are needed to delineate the rate of occurrence, risk factors, and clinical implications of hypogammaglobulinemia in this patient population.