Administration of immunoglobulins reduced the overall rate of infections [5-9], suggesting click here that IVIg administration might be associated with some reconstitution of

the immune system. Additionally, when looking specifically at CMV infection, recipients who received immunoglobulins displayed a lower rate of infection [5, 8, 9]. Two studies published by Carbone et al. found no impact of IVIg administration on rejection rate [5, 6]. However, the studies published by Yamani demonstrated a significant reduction in the occurrence of grade 2 and 3 rejection [8, 9], and these results were supported by the results from Nathan et al. [7]. Although three of the studies reported on mortality [5-7], the event rates in these studies were very low, making it difficult to draw valid

LY294002 concentration conclusions. Nonetheless, as the main cause of mortality in SOT patients is infection, it can be expected that if the rate of infection is reduced, then mortality rates should also decrease. Although studies to date have focused on IVIg replacement therapy, there are emerging data regarding subcutaneous immunoglobulin (SCIg). One recent study, a retrospective analysis of 10 lung transplant recipients with severe HGG, compared treatment with SCIg (six patients) with treatment with SCIg following a loading dose with IVIg (four patients) [10]. IgG levels were increased in all 10 patients at 3 months, and this level was sustained at 6–12 months after SCIg administration. In addition, the majority of patients (70%) tolerated SCIg therapy without complications; the remainder of the patients experienced infusion site reactions which resolved within 24 h [10]. These results indicate that SCIg may be a viable alternative to IVIg treatment for HGG. A survey to assess practice variation in intestinal transplant programmes registered

with the Intestinal Transplant Association found that 26·9% of the programmes surveyed perform screening for HGG during the first year following transplantation, including routine screening and screening in patients with severe infection [11]. Once diagnosis has been made, IVIg is pre-emptively administered for mild HGG in only 7·7% of these programmes, while 53·9% will treat patients with severe HGG [11]. In conclusion, HGG is highly prevalent, and severe HGG is associated with Clomifene a significantly increased risk of infection. It remains unclear whether there is a causal relationship between HGG and infections, or if HGG is just a marker of severe immunosuppression. HGG, and especially severe HGG, have a negative impact on mortality, but not on rejection rates. Treatment with immunoglobulins can reduce the incidence of infection; more studies are required to assess the impact of immunoglobulin treatment on mortality. D. F. would like to thank Meridian HealthComms Ltd for providing medical writing services. D. F.