*Purpose: Hypogammaglobulinemia (HGG) is a complication of solid organ transplantation which has been associated with increased risk of infections. HGG is commonly defined as a serum immunoglobulin G (IgG) level <700 mg/dL. Intravenous immunoglobulin G (IVIG) replacement in patients with HGG may be able to reduce rates of infection; however, few studies have assessed the use of IVIG to reduce risk of recurrent infection for heart transplant recipients with HGG. The primary objective of this study is to describe the effect of using IVIG in patients with HGG and documented infections on the recurrence of infections within 6 months of the initial infection compared to patients with a documented infection who did not receive IVIG.

*Methods: A single center, retrospective study was performed assessing heart transplant recipients transplanted from 2011 to 2020 admitted inpatient between October 2017 to May 2020 with a documented infection and serum IgG level <700. Patients were grouped based on those who did or did not receive IVIG during hospital admission. Patients were excluded if they received IVIG or other immune globulin products for indications other than HGG one month prior to the use of IVIG and HGG.

*Results: Thirty-six patients were included in this study. Patients in the IVIG group received on average 1 dose of IVIG at 0.5 g/kg. Use of IVIG resulted in a significant median increase in serum IgG levels of 481 to 672 (p<0.001). Despite this observed increase, there were no differences in the primary outcome of recurrent infections at 6 months (4 vs 0, p=0.19) and similar recurrence when grouped based on severity of HGG. Additionally, there were no differences in the rate of recurrent and new infections at 3 and 12 months (see table). Severity of HGG was not a factor associated with recurrent infections within 6 months (p=0.32).

*Conclusions: This cohort had a low number of recurrent infections. There were no differences observed between those who did or did not receive IVIG. Larger prospective studies are needed to confirm these findings.

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