Introduction: Desensitization therapies (DES) have dramatically improved rates of transplantation among HS patients. However, antibody-reduction and B-cell/plasma cell directed therapies could have implications for humoral immunity to infections. Although data from centers performing DES suggests infectious complications are similar to non-HS patients, the incidence of secondary hypo-IgG is unknown. Here, we examined the incidence and severity of IgG deficiency in a cohort of patients DES with IVIG+rituximab ± PLEX. Patient & Method: From 3/09–2/14, 37 tx HS patients who received DES with IVIG+Ritux (n=27) ±PLEX (n=10) who had available sera obtained from pre-DES and 12M post-tx were analyzed for total IgG. Results were correlated with serious infectious complications (those requiring IV antibiotics or hospitalization). Patients were separated into two groups: Those with IgG levels <499 mg/dl and those >500 mg/dl. It is generally accepted that levels <499 predispose to infectious complications such as pneumonia, sinusitis, GI and possibly UTIs. Results: The mean IgG levels prior to DES were 810±213 and were 650±214 @12M (p<0.0006). Although significant, these were not clinically relevant. Nine of 37 (24%) patients had IgG levels <499 mg/dl. Of those 8 of 9 (89%) had UTI infections (enterococcus, E. Coli, coagulase (-) staph aureus); 1 of 9 (11%) had pseudomonas abscess; 2 of 9 (22%) had yeast in respiratory culture; 1 of 9 (11%) had sepsis from enterobacter aerogenes. None of these patients required chronic IVIG therapy. The remaining 28 patients had IgG levels >500 mg/dl. Of those, 8 (29%) had serious infections requiring hospitalization/IV antibiotics {7 were with UTIs and URIs}, one required chronic IVIG therapy. A separate group of transplanted patients who required chronic IVIG therapy (n= 17) were assessed. Eleven of 17 (65%) received DES prior to or at transplant, 6 of 11 (55%) presented with recurrent infections which suggested secondary immunodeficiency. In this group, the mean IgG levels were 479±104 mg/dl. Conclusions: Total IgG levels were not routinely assessed in >600 HS patients DES since 2004. However, the incidence of true hypo-IgG requiring chronic IVIG after DES is rare. IVIG replacement therapy is effective in those with infectious complications.

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