Immunoglobulin replacement therapy decreases infection frequency in patients with primary immunodeficiency; however, there is limited data regarding the use of intravenous immunoglobulin (IVIG) or subcutaneous immunoglobulin (SCIG) in the treatment of hypogammaglobulinemia (HGG) or frequent infections in pediatric renal transplant patients.

A retrospective chart review was conducted of pediatric renal transplant patients at a single academic medical center referred to pediatric immunology for evaluation of recurrent infections and treatment with IVIG or SCIG between July 2016 and October 2017. Etiology of renal failure, date of transplant, immunosuppressive therapies, frequency and type of infections, hospitalizations for infection, immune-based tests and efficacy and tolerability of IVIG or SCIG were reviewed.

Four patients, 3 male and 1 female, with a significant infection history on immunosuppressive therapies were identified. 3 had HGG, 3 had impaired vaccine response and all had variable T-cell deficiency. Immune parameters did not correlate with time since transplant, immunosuppressive therapy or infection-related hospitalization frequency. 2 of 3 patients treated with IVIG had significant side effects and were subsequently treated with SCIG, which was well tolerated. 2 patients tolerated IVIG. Infection-related hospitalizations decreased from 4 to 1.5/yr in the SCIG group and from 2 to 1.5/yr in the IVIG group.

HGG is a well recognized complication of solid organ transplantation and is associated with an increased rate of infection. Patients treated with SCIG had greater reduction in infection-related hospital admissions compared to those on IVIG. SCIG was better tolerated than IVIG. While this study is limited by small sample size and short duration of follow-up, it is the first to report on SCIG in pediatric renal transplant patients. SCIG appears to be safe, well-tolerated and effective in decreasing infection-related hospitalizations in this patient population. Further research is needed to better define patients most likely to benefit from SCIG.

CITATION INFORMATION: Lewis A., Fasano M., Zepeda-Orozco D. Immunoglobulin Replacement Therapy in Pediatric Renal Transplant Patients Am J Transplant. 2017;17 (suppl 3).

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