Decreased levels of serum complement C3 and natural killer cells add to the predictive value of total immunoglobulin G for severe infection in heart transplant recipients.

BACKGROUND: Infection remains a source of mortality in heart recipients. We previously reported that post-transplant immunoglobulin G (IgG) quantification can help identify the risk for infection. We assessed whether other standardized parameters of humoral and cellular immunity could prove useful when identifying patients at risk of infection. METHODS: We prospectively studied 133 heart recipients over a 12-month period. Forty-eight patients had at least one episode of severe infection. An event was defined as an infection requiring intravenous antimicrobial therapy. RESULTS: Cox regression analysis revealed an association between the risk of developing infection and the following: lower IgG2 subclass levels (day 7: relative hazard [RH] 1.71; day 30: RH 1.76), lower IgA levels (day 7: RH 1.61; day 30: RH 1.91), lower complement C3 values (day 7: RH 1.25), lower CD3 absolute counts (day 30: RH 1.10), lower absolute natural killer [NK] cell count (day 7: RH 1.24), and lower IgG concentrations (day 7: RH 1.31; day 30: RH 1.36). Cox regression bivariate analysis revealed that lower day 7 C3 levels, IgG2 concentration, and absolute NK cell count remained significant after adjustment for total IgG levels. CONCLUSIONS: Data suggest that early immune monitoring including C3, IgG2, and NK cell testing in addition to IgG concentrations is useful when attempting to identify the risk of infection in heart transplant recipients.

Restoration of humoral immunity after intravenous immunoglobulin replacement therapy in heart recipients with post-transplant antibody deficiency and severe infections.

IgG hypogammaglobulinemia is a risk factor for infection in heart recipients. We assessed reconstitution of humoral immunity after non-specific intravenous immunoglobulin (IVIg) replacement therapy administered to treat secondary IgG hypogammaglobulinemia in heart recipients with severe infections. The study population comprised 55 heart recipients who were administered IVIg (IVIg group) and 55 heart recipients with no severe infectious complications (control group). An event was defined as a severe infection requiring intravenous drug therapy during the first year after transplantation. The IVIg protocol comprised non-specific 5% pasteurized IVIg at a dose of 300-400 mg/kg/months. IgG titers were lower in the IVIg group than in controls at seven d (577 vs. 778 mg/dL, p < 0.001) and at one month (553 vs. 684, p = 0.003). After IVIg therapy, IgG concentrations were similar in both groups at three months (681 vs. 737, p = 0.25) and at six months (736 vs. 769, p = 0.46). At three months, the IVIg group had higher levels of antitetanus toxoid and anti-HBs (ELISA, 2.07 ± 2.11 vs. 0.60 ± 1.24 mg/dL [p = 0.003] and 42 ± 40 vs. 11 ± 31 IU/mL [p = 0.005], respectively) than controls. The mean number of infectious complications was significantly lower after IVIG therapy in the IVIG group. IVIg was associated with restoration of humoral immunity in heart recipients with post-transplant IgG hypogammaglobulinemia and severe infections.

Utility of oligoclonal IgG band detection for MS diagnosis in daily clinical practice.

An early and accurate diagnosis of multiple sclerosis (MS) is very important, since it allows early treatment initiation, which reduces the activity of the disease. Oligoclonal IgG band (OCGB) detection is a good ancillary tool for MS diagnosis. However, it was argued that its usefulness was limited by the high interlaboratory variability. In the last years, different techniques for OCGB detection have appeared. We performed a blinded aleatorized multicenter study in 19 Spanish hospitals to assess the accuracy and reproducibility of OCGB detection in this new scenario. We studied cerebrospinal fluid (CSF) and serum samples from 114 neurological patients. Every hospital contributed to the study with triplicated pairs of CSF and serum samples of six patients and analyzed 18 different samples. Global analysis rendered a sensitivity of 92.1%, a specificity of 95.1% and a Kappa value of 0.81. This shows that current techniques for OCGB detection have good accuracy and a high interlaboratory reproducibility and thus, represent a good tool for MS diagnosis. When we analyzed separately the different techniques used for OCGB detection, the highest concordance was observed in western blot with alkaline phosphatase detection (kappa=0.91). This indicates that high sensitivity techniques improve the reproducibility of this assay.

Elaboración de un instrumento de diagnóstico y diagnóstico diferencial en transexualidad / Preparation of a diagnostic and differential diagnosis tool in transsexualism

Introducción. La transexualidad es un fenómeno emergente para el que no existen instrumentos diagnósticos apropiados. La transexualidad consiste en sentirse pertenecer al sexo contrario al genético. Este sentimiento debe ser persistente y provocar malestar clínicamente significativo. Además no debe ser explicable por un trastorno psiquiátrico. Este trastorno se ha diagnosticado hasta ahora usando solamente la entrevista. Tras una revisión de la bibliografía existente, se determina la necesidad de un instrumento diagnóstico específico y basado en las normas DSM-IV-TR. El objetivo de este estudio es crear una prueba diagnóstica fiable. Además, la herramienta debe realizar un diagnóstico diferencial de otros trastornos con los que se podría confundir. Material y métodos. Se usó un diseño transversal para la validación del instrumento. Tras su elaboración se aplicó a 86 sujetos de la Unidad de Trastornos de Identidad de Género del Hospital Ramón y Cajal, de Madrid, y se procedió a su análisis estadístico. Todos los ítems estuvieron basados en el DSM-IV-TR. La aplicación de las pruebas se llevó a cabo durante el proceso habitual de evaluación psicológica. Se midió transexualidad, así como 7 diagnósticos diferenciales (disfunciones y desviaciones sexuales). Resultados y conclusiones. Se obtuvo una gran fiabilidad en el conjunto del test, así como en todas sus escalas e ítems. Este nuevo instrumento resultó ser fiable para un diagnóstico inicial de transexualidad (AU)

Introduction. Transsexualism is an emerging phenomenon so there are no appropriate diagnostic tools in this field. Transsexualism is a sense of feeling like a member of the opposite genetic sex. This feeling must be persistent and clinically troublesome. It also must not be able to be explained by a psychiatric disorder. Transsexualism has been diagnosed only with interview. After a review of current literature, it can ne seen that there is need for a specific diagnostic tool based on the standard DSM-IV-TR. The aim of this study was to create a reliable diagnostic test. Moreover, the tool must be able to make a differential diagnosis as regards other disorders which can be confused with it. Material and method. A cross design was used for validation of the instrument. After constructing the test, it was applied to 86 subjects of the Gender Identity Disorders Unit of the Ramon y Cajal Hospital, Madrid, and then statistically analysed. All items were based on the DSM-IV-TR. The tests were applied during the usual process of psychological assessment. We measured transsexuality and seven differential diagnoses (sexual deviations and dysfunctions). Results and conclusions. We found high reliability throughout the test, and on all scales and items. This new tool seems to be useful and reliable for the initial diagnosis of transsexualism (AU)

Abordaje multidisciplinar de la transexualidad: desde atención primaria a la Unidad de Trastornos de Identidad de Género de Madrid (UTIG MADRID) / Multidisciplinary approach to Transsexuality: From Primary Care to the Gender Identity Disorders Unit in Madrid (GIDU-Madrid)

La transexualidad es un fenómeno emergente en nuestra sociedad, por el cual una persona de un sexo biológico se siente pertenecer al contrario. El abordaje realizado desde la Unidad de Trastornos de Identidad de Género del Hospital Ramón y Cajal parte de un enfoque multidisciplinar y se basa en que el tratamiento no debe limitarse al médico (hormonal y cirugía de reasignación de sexo) sino que es fundamental la intervención psicológica. Este proceso multidisciplinar exige varias fases de evaluación psicológica. La intervención psicológica debe ser individualizada y los objetivos terapéuticos que se plantean son, entre otros, apoyo en dificultades cognitivas o emocionales, desarrollo de estrategias de afrontamiento y adherencia al tratamiento médico (AU)

Transsexuality is an emergent phenomenon in our society. It means, that a person belonging to one biological sex feels that he/she belongs to the opposite one. The Gender Identity Disorder Unit of Madrid is achieving a cross-disciplinary approach. This approach is not just based on medical treatment, or hormonal or surgical treatments, but psychological treatment is also essential. This cross-disciplinary process requires several stages of psychological assessment. Psychological treatment must be individualized. The therapeutic goals should be: Support in cognitive and emotional difficulties, the development of coping skills, and adherence to the medical treatment (AU)

Humoral and cellular immune monitoring might be useful to identify liver transplant recipients at risk for development of infection.

Orthotopic liver transplantation (OLT) is a successful therapy for patients with end-stage liver disease, and infection remains a significant cause of morbidity and mortality for patients undergoing this procedure. To assess humoral and cellular immunity markers as potential risk factors for development of infection, 46 consecutive liver transplant recipients (hepatitis C virus cirrhosis [n=17], alcoholic liver disease [n=15], hepatocellular carcinoma [n=9], autoimmune hepatitis [n=2], and other [n=3]) performed at a single center were prospectively studied. Maintenance therapy included tacrolimus (n=37) or cyclosporine (n=9) and prednisone. During follow-up, 27 patients had at least 1 episode of infection (58.7%). Pre-OLT immunoglobulin G (IgG) hypergammaglobulinemia (relative risk [RR] 2.78; 95% confidence interval [CI], 1.17-6.60, P=0.02), pre-OLT IgA hypergammaglobulinemia (RR 2.77, CI=1.24-6.19, P=0.012), and pre-OLT C3 hypocomplementemia (RR 3.02, CI=1.21-7.55, P=0.018) were associated with an increased risk for development of infection. Monitoring of Ig and complement levels might help to identify the risk of developing infection in OLT.

Hipocomplementemia C3 y C4 en el síndrome antifosfolípido obstétrico / C3 and C4 hypocomplementemia in obstetric antiphospholipid syndrome

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The potential impact of substitutive therapy with intravenous immunoglobulin on the outcome of heart transplant recipients with infections.

Hypogammaglobulinemia has been proposed to be a risk factor for infection after heart transplantation (OHT). Infection is a leading cause of morbility and mortality among these patients. In a retrospective study we analyzed the impact of substitutive therapy with nonspecific intravenous immunoglobulin (IVIG) on the outcomes of heart transplant patients with infections. We analyzed the outcome of 123 consecutive heart transplant recipients in our center from June 1996 to November 2005. Their mean age was 53 years (range = 22 to 69 years), and the mean follow-up = 51 months, (range = 1 to 124 months). Twenty-nine patients with hypogammaglobulinemia (mean serum immunoglobulin G levels = 480 mg/dL) experienced severe infections due to cytomegalovirus (CMV) disease, n = 4; CMV disease + another infection, n = 6; CMV infection, n = 4; CMV infection + other infection, n = 3; pulmonary nocardiosis, n = 2; recurrent pneumonia, n = 2; clostridium-difficile-associated diarrhea, n = 2; pulmonary tuberculosis, n = 1; bacterial infections, n = 5. They were treated with IVIG (400 mg/kg every 21 days) with the goal to reach normal serum immunoglobulin G levels (>700 mg/dL). Overall (n = 123), a logistic regression analysis showed IVIG therapy to be associated with a decreased risk of death [odds ratio (OR) = 0.204, 95% confidence interval (CI) = 0.04 to 0.92, P = .03]. Among patients who developed infections during follow-up (n = 70), IVIG therapy was also associated with a lower risk of death (OR = 0.104, CI = 0.02 to 0.50, P = .0047). When we stratified patients with CMV disease (n = 24) according to the presence (n = 10) or absence (n = 14) of IVIG therapy, the mortality rate of IVIG-treated patients was 20% versus 71% for non-IVIG treated patients [OR = 0.06, CI = 0.0060 to 0.63, P = .01]. The use of nonspecific IVIG in OHT with hypogammaglobulinemia and infections might reduce the risk of death. Randomized studies in a larger cohort of patients are necessary to confirm these results.

Humoral and cellular monitoring to predict the development of infection in Crohn's disease patients beginning treatment with infliximab.

Although severe infectious complications are rare, it is important to properly screen patients for predisposing conditions before beginning treatment with infliximab. We assessed immunity markers that might provide prognostic value for the development of infection in Crohn's disease patients after treatment with infliximab. In a prospective study, 34 fistulizing Crohn's disease patients (mean age 37 years) were studied. Patients were scheduled to receive three infusions of infliximab (5 mg/kg) at weeks 0, 2, and 6. Immunologic studies: Serum immunoglobulin (IgG, IgA, IgM), IgG-subclasses, and complement (C3, C4, factor B) determined by nephelometry; CD3+, CD3+CD4+, CD3+CD8+, CD19+, and CD56+CD3- lymphocyte subsets performed by flow cytometry. During a mean follow-up of 56 months, 1 patient had disseminated tuberculosis and 2 patients had severe bacterial infections. The presence of infection was associated with significantly higher IgM (246 vs. 121 mg/dL; Mann-Whitney test, P = 0.01), lower C3 (64 vs. 118, P = 0.02), lower C4 concentrations (12 vs. 25, P = 0.02), and with decreased levels of CD19 B cells (47 vs. 290, P = 0.03) in the baseline study. Further prospective studies in a larger number of patients are suggested to examine whether early monitoring of immunocompetence might help to identify the risk of infection in patients treated with infliximab.

Hypocomplementemia in the absence of autoantibodies in women with recurrent pregnancy loss.

BACKGROUND: Accumulating data suggest an immunopathogenic role for the complement system as a causative element in pregnancy loss (PL). Formation of pathogenic antibodies with activation of the classical pathway may have a role, but this mechanism fails to characterize the majority of cases with recurrent PL. We established the prevalence of hypocomplementemia without circulating autoantibodies in women with recurrent PL. METHODS: In a retrospective case control study, 201 women with recurrent PL (two or more PL) and 30 healthy women who had normal pregnancies but no PL were studied. Serum levels of C3, C4, and factor B were determined by nephelometry. Total hemolytic activity of the complement system (CH100) was investigated by radial immunodiffusion test. RESULTS: The prevalence of hypocomplementemia [low levels of C3, C4, FB or CH100 (with normal concentrations of C3, C4 and FB)] was significantly higher in women with recurrent PL (22.4%) in comparison with controls (6.6%; p = 0.019). C3, C4, FB hypocomplementemia or low CH100 were observed in 13 (6.5%), 19 (9.4%), 13 (6.5%) and 7 (3.5%) women with recurrent PL, respectively. Among patients with C3, C4, FB or CH100 hypocomplementemia, 10, 18, 12 and 5 patients had no circulating autoantibodies [antinuclear antibodies, anticardiolipin antibodies or antithyroid antibodies], respectively. In all, hypocomplementemia, in the absence of autoantibodies, was observed in 38 (18.9%) women with recurrent PL in a significantly higher frequency than controls (n = 2, p = 0.049). CONCLUSIONS: Hypocomplementemia, in the absence of autoantibodies was observed in a group of women with recurrent PL which might suggest a role of the complement system in the pathogenesis of PL in these patients.

Partial response to cyclosporine in a patient with Schnitzler's syndrome.

Schnitzler's syndrome is an unusual clinical association of chronic urticaria, intermittent fever and monoclonal immunoglobulin M (IgM) gammopathy. The pathogenesis of the urticaria is unclear and treatment is problematic. We describe the case of a 61-year-old woman with a long history of chronic urticaria with severe pruritus, spiking fever and malaise. The IgM-kappa monoclonal component was detected in the patient's serum 4 years after symptom onset. After ineffective treatment with antihistamines and systemic corticosteroids, oral cyclosporine resulted in complete remission of the fever and malaise, which has persisted after an 18-month follow-up. Partial but maintained remission of the urticaria was also observed, allowing corticosteroid doses to be decreased.

Partial response to Cyclosporine in a patient with Schnitzler's syndrome / Reactividad cruzada entre la parietaria y la acelga

Schnitzler's syndrome is an unusual clinical association of chronic urticaria, intermittent fever and monoclonal immunoglobulin M (IgM) gammopathy. The pathogenesis of the urticaria is unclear and treatment is problematic. We describe the case of a 61-year-old woman with a long history of chronic urticaria with severe pruritus, spiking fever and malaise. The IgM-kappa monoclonal component was detected in the patient's serum 4 years after symptom onset. After ineffective treatment with antihistamines and systemic corticosteroids, oral cyclosporine resulted in complete remission of the fever and malaise, which has persisted after an 18-month follow-up. Partial but maintained remission of the urticaria was also observed, allowing corticosteroid doses to be decreased

La alergia a la acelga es muy rara. Hasta este momento ha habido solamente informes sobre el asma inducido por el vapor de la acelga cocinada. Presentamos un estudio de dos pacientes con rinitis alérgica y positividad al prick test por Parientaria y acelga solamente. En la hipótesis de una reactividad cruzada entre el polen de Parietaria y la acelga, realizamos algunos análisis del laboratorio que demostraron IgE acelga -específica en sueros de los dos pacientes y una reactividad cruzada posible entre Parietaria y la acelga en un paciente

Impaired anti-pneumococcal polysaccharide antibody production and invasive pneumococcal infection following heart transplantation.

An increased risk of invasive pneumococcal infection has been described among adult heart transplant (HT) recipients. Vaccination has been recommended before HT but the appropriate time for revaccination is not known. In a preliminary analysis of a prospective study involving a cohort of 32 HT recipients receiving daclizumab and triple immunosuppresion therapy, a progressive decline in pneumococcal polysaccharide antibody (anti-PPS) levels was observed during the first year after HT. One of the patients who was found to have a decrease in the levels of anti-PPS developed severe pneumococcal meningitis 20 months after HT. Before HT he had received non-conjugated 23-valent pneumococcal vaccine and showed a normal post-immunization anti-PPS production. The data suggest that long-term immunologic monitoring might be useful to recognize impairment of antibody responses under immunosuppressive therapy in HT.

Elevated levels of activated CD4 T cells in common variable immunodeficiency: association with clinical findings.

BACKGROUND: Common variable immunodeficiency (CVID) is a very heterogeneous syndrome defined by impaired immunoglobulin production. The primary defect remains unknown, but many reports describe peripheral blood T and B lymphocyte dysfunctions in a substantial proportion of CVID patients. Immunophenotypic alterations on memory B lymphocytes correlate with clinical findings. A B-cell-oriented classification principle of the patients has been proposed. METHODS AND RESULTS: We investigated the expression of activation surface molecules on CD4 and CD8 T-cells from 14 patients with CVID, 6 non-CVID hypogammaglobulinemic patients with recurrent infections, 47 asymptomatic HIV-positive patients without AIDS defining conditions and 23 healthy subjects. Lymphocyte subsets were analysed by three-colour flow cytometry. Monoclonal panel: CD38-FITC/HLADR-PE/CD4 or CD8-PerCP. In CVID patients serum levels of CD4 T-cells co-expressing the activation marker HLA-DR [CD4+DR+ (34 %), CD4+CD38+DR+ (18 %)] were significantly elevated compared with controls. Significant increases in CD8+DR+ (54%), CD8+ CD38+ (43%) and CD8+CD38+DR+ (29%) T-cells were observed in comparison with healthy controls. CVID patients with splenomegaly, lower pre-infusion IgG levels (< 600 mg/dl), autoimmune or lymphoproliferative conditions demonstrated even higher levels of CD4+CD38+DR+T cells (22, 22, 21 and 21% respectively) compared with other CVID patients (13, 13, 15 and 15% respectively). CONCLUSION: These findings indicate a state of ongoing T lymphocyte activation which is associated with clinical findings frequently observed in CVID.

Elevated levels of activated CD4 T cells in common variable immunodeficiency: association with clinical findings / Valores aumentados de células T CD4+ activadas en pacientes con inmunodeficiencia variable común: asociación con características clínicas

Background. Common variable immunodeficiency (CVID) is a very heterogeneous syndrome defined by impaired immunoglobulin production. The primary defect remains unknown, but many reports describe peripheral blood T and B lymphocyte dysfunctions in a substantial proportion of CVID patients. Immunophenotypic alterations on memory B lymphocytes correlate with clinical findings. A B-cell-oriented classification principle of the patients has been proposed. Methods and results. We investigated the expression of activation surface molecules on CD4 and CD8 T-cells from 14 patients with CVID, 6 non-CVID hypogammaglobulinemic patients with recurrent infections, 47 asymptomatic HIV-positive patients without AIDS defining conditions and 23 healthy subjects. Lymphocyte subsets were analysed by three-colour flow cytometry. Monoclonal panel: CD38-FITC/HLADR-PE/CD4 or CD8-PerCP. In CVID patients serum levels of CD4 T-cells co-expressing the activation marker HLA-DR [CD4+DR+ (34 %), CD4+CD38+DR+ (18 %)] were significantly elevated compared with controls. Significant increases in CD8+DR+ (54 %), CD8+ CD38+ (43 %) and CD8+CD38+DR+ (29 %) T-cells were observed in comparison with healthy controls. CVID patients with splenomegaly, lower pre-infusion IgG levels (< 600 mg/dl), autoimmune or lymphoproliferative conditions demonstrated even higher levels of CD4+CD38+DR+T cells (22, 22, 21 and 21 % respectively) compared with other CVID patients (13, 13, 15 and 15 % respectively). Conclusion. These findings indicate a state of ongoing T lymphocyte activation which is associated with clinical findings frequently observed in CVID

Fundamento. La inmunodeficiencia variable común (IDVC) es una enfermedad caracterizada por una deficiencia en la formación de anticuerpos. El defecto primario sigue sin conocerse, pero los pacientes exhiben alteraciones funcionales de los linfocitos T y B. Recientemente se ha demostrado que las alteraciones inmunofenotípicas de los linfocitos B se correlacionan con características clínicas de la enfermedad, habiéndose propuesto clasificaciones de los pacientes sobre la base de las alteraciones inmunofenotípicas. Métodos y resultados. Mediante un estudio descriptivo transversal, comparamos la expresión de marcadores de activación linfocitaria sobre células T CD4+ y CD8+ de 14 pacientes con IDVC, 6 pacientes con hipogammaglobulinemia (sin criterio de IDVC), 47 pacientes con infección VIH sin criterio clínico de SIDA y 23 controles sanos. Las subpoblaciones linfocitarias se estudiaron mediante citometría de flujo de tres colores. Panel de anticuerpos monoclonales: CD38-FITC/HLADR-PE/CD4 o CD8-PerCP. El porcentaje medio de linfocitos T CD4+DR+ (34%), CD4+CD38+DR+ (18%) en los pacientes con IDVC era mayor que en los controles. Los pacientes con IDVC tenían valores más altos de células T CD8+DR+ (54%), CD8+CD38+ (43%) y CD8+CD38+DR+ (29%) que los controles sanos. Los pacientes con IDVC que tenían esplenomegalia, niveles más bajos de IgG pre-infusión de GGIV (<600 mg/dl), enfermedad autoinmune o condiciones linfoproliferativas, mostraron valores mayores de linfocitos T CD4+CD38+DR+ (22%, 22%, 21% y 21%, respectivamente) en comparación con pacientes con IDVC sin estas condiciones clínicas (13%, 13%, 15% y 15%, respectivamente). Conclusiones. Valores mayores de activación linfocitaria de células T CD4+ se asocian con ciertas características clínicas en pacientes con IDVC

[Systemic autoimmune disease in patients with uveitis]. / Enfermedad autoinmune sistémica en pacientes con uveítis.

OBJECTIVE: A descriptive study was conducted on patients with uveitis to determine the frequency of associated autoimmune systemic diseases. METHODS: 64 patients with uveitis were studied. The patients were not known to have an underlying autoimmune systemic disease prior to the diagnosis of uveitis. All patients had the following immunological tests performed: serum immunoglobulins, complement components, circulating immune complexes (CIC), antinuclear antibodies (ANA), anti-neutrophil cytoplasmic antibodies (ANCA), anti-cardiolipin antibodies (ACA) and major histocompatibilty complex antigens. RESULTS: A relationship with a sub-clinical autoimmune systemic disorder could be presumed in eleven cases (17.2%). This was defined by positive autoantibodies (ANA, ANCA or ACA) in the presence of complement consumption, hyper-gammaglobulinemia or increased CIC without clinical criteria of a defined autoimmune disease. A definite association with systemic autoimmune disease was defined in four patients (6.25%). The observed autoimmune systemic diseases were Sjögren's syndrome (n=2, 3.13%), anti-phospholipid syndrome associated with lupus-like disease (n=1, 1.6%), and systemic vasculitis (n=1, 1.6%). Lupus-like disease (n=4, 6.25%) was also observed. CONCLUSION: In a significant proportion of patients with uveitis an autoimmune systemic disorder may be present and should be looked for.

IgG monitoring to identify the risk for development of infection in heart transplant recipients.

Infectious complication represents a significant source of morbidity and mortality in heart transplant recipients. To assess humoral immunity markers that can predict the development of infection, 38 consecutive recipients of heart transplants performed at a single center were prospectively studied. Induction therapy included daclizumab. Immunoglobulin (IgG, IgA, IgM) and complement factors (C3, C4, and factor B) were performed by nephelometry in peripheral blood samples obtained before transplantation, and 7 days and 1 month after transplantation. During a mean follow-up of 16.9 months, 13 patients had at least one episode of infection (34.2%). Eight of these were cytomegalovirus (CMV) infections treated with intravenous ganciclovir, 2 were bacterial pneumonia, 1 patient had bacterial septicemia, 1 patient had urinary tract infection, and 1 patient had pulmonary nocardiosis. No significant association was found between infection and age, sex, immunosuppression, CMV serostatus of donor and recipient, or treated rejection episodes. Pre-transplant IgG (below median value=1140 mg/dL; relative risk [RR] 3.69; 95% confidence interval [CI] 1.01-13.54; P=0.04) and post-transplant IgG levels at day 7 (below median value=679 mg/dL; RR 11.21; CI 1.04-89.48; P=0.022) were associated with an increase in the risk for developing infections. Early monitoring of immunoglobulin levels might help to identify the risk for developing infection in heart transplantation.