Infection is the first cause of death during the first year after heart transplantation according to the registry of the international society for heart and lung transplantation (2018). A complex secondary immunodeficiency (CSID) may affect a small number of heart recipients after transplantation and predispose them to severe or recurrent infections. We aimed to analyze the prevalence of this immunological complication in a cohort of heart recipients performed in a single center.
Prospective cohort follow-up. The CSID was defined as severe or recurrent infection requiring hospitalization including more than one type of microorganisms (i.e. bacterial + invasive fungal or bacterial + CMV disease) persisting after 6 months. Immunoglobulins, IgG subclasses, specific antibodies, C3, C4 and MBL complement factors and lymphocyte subsets were performed at 30 days after transplantation to define the combined secondary immunodeficiency status. A follow-up of 12 months was required to recruit patients.
200 heart transplant recipients were evaluated. A total of 12 (6%) patients were found to have severe or recurrent infections persisting more than 6 months. IgG, IgA, IgM, IgG1, IgG2, anti-pneumococcal polysacharide antibody, anti-CMV antibody levels, CD3, CD4 and CD8 cells/uL were lower in these patients as compared with the rest of the cohort. In multivariate regression models IgG levels remained as the most strong predictor.
A CSID status including humoral and cellular immunity parameters was demonstrated in a small group of heart transplant recipients. A continuous highly specialized immunological monitoring is warranted after transplantation to detect this severe complex clinical setting.