Post‐transplant hypogammaglobulinemia and risk of infection after kidney transplantation: Magnitude matters

We have read with interest the paper by Augusto et al.1 analyzing the association between post-transplant hypogammaglobulinemia (HGG) and the incidence of severe infection in a single-center cohort of kidney transplant (KT) recipients. By measuring serum immunoglobulin (Ig) levels at different time points up to month 24 post transplant, the authors reported that infection-free survival did not significantly differ between patients with or without IgG HGG (<700 mg/dL) at day 15. This lack of association remained when the severity of HGG was stratified according to IgG levels or when HGG of any class (IgG, IgA, and/or IgM) was used as predictor variable. Similar results were obtained for HGG at month 6 and with late infection, although the number of events analyzed was low. These findings led the authors to question the impact of post-transplant HGG on the susceptibility to infectious complications and, therefore, the potential utility of intravenous Ig (IVIg) replacement therapy. This article is protected by copyright. All rights reserved.