Efficacy of IgM-enriched Immunoglobulin for Vasopressor-resistant Vasoplegic Shock after Liver Transplantation

Katharina Willuweit, Dmitri Bezinover, Kerstin Herzer, Knut M. Nowak, Andreas Paul, Fuat H. Saner

Research output: Contribution to journalReview article

Abstract

Background Vasoplegia is a clinical condition typically manifested by cardiovascular instability unresponsive to the usual doses of inotropes or vasopressors. It can occur in a variety of clinical settings including liver transplantation (LT). Immunoglobulins have been used to treat sepsis-related vasoplegia. We performed a retrospective study to evaluate the efficacy of IgM-enriched immunoglobulin (IgMIg) on 30-day mortality and its ability to reverse vasoplegia in patients undergoing LT. Methods Between May 2013 and November 2017, 473 LT were performed at our institution. We identified 21 patients who received IgMIg for 3 days to treat vasoplegia. Patients included in the study met the criteria for having vasoplegia and required noradrenaline administration greater than 1 μg·kg-1·min-1 for more than 24 hours to maintain a mean arterial pressure of 70 mm Hg or greater. Procalcitonin and interleukin-6 (IL-6) levels were used as surrogate markers for inflammation and were measured at the beginning and end of IgM treatment. Results After IgMIg administration, median noradrenaline infusion rates could be significantly reduced from 1.6 μg·kg-1·min-1 (1.3-2 μg·kg-1·min-1) to 0.16 μg·kg-1·min-1 (0.08-0.34 μg·kg-1·min-1) (P < 0.001). In addition, after treatment, procalcitonin levels decreased significantly from 44 ng/mL (24-158) to 26.1 ng/mL (10.9-48.7) (P < 0.001) and IL-6 levels decreased significantly from 63 pg/mL (29-102) to 20 pg/mL (11-20) (P < 0.001). Thirty-day morality was 14.3%. Conclusions The administration of IgMIg in patients with vasoplegia after LT is associated with a return of hemodynamic stability. Despite a predicted mortality of over 90% by Sepsis-Related Organ Failure Assessment score, the mortality rate of patients receiving IgMIg in our study was less than 20%.

Original languageEnglish (US)
Pages (from-to)381-386
Number of pages6
JournalTransplantation
Volume103
Issue number2
DOIs
StatePublished - Feb 1 2019

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Vasoplegia
Liver Transplantation
Immunoglobulin M
Immunoglobulins
Shock
Calcitonin
Mortality
Interleukin-6
Sepsis
Norepinephrine
Organ Dysfunction Scores
Aptitude
Arterial Pressure
Retrospective Studies
Biomarkers
Hemodynamics
Inflammation
Therapeutics

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Willuweit, Katharina ; Bezinover, Dmitri ; Herzer, Kerstin ; Nowak, Knut M. ; Paul, Andreas ; Saner, Fuat H. / Efficacy of IgM-enriched Immunoglobulin for Vasopressor-resistant Vasoplegic Shock after Liver Transplantation. In: Transplantation. 2019 ; Vol. 103, No. 2. pp. 381-386.
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title = "Efficacy of IgM-enriched Immunoglobulin for Vasopressor-resistant Vasoplegic Shock after Liver Transplantation",
abstract = "Background Vasoplegia is a clinical condition typically manifested by cardiovascular instability unresponsive to the usual doses of inotropes or vasopressors. It can occur in a variety of clinical settings including liver transplantation (LT). Immunoglobulins have been used to treat sepsis-related vasoplegia. We performed a retrospective study to evaluate the efficacy of IgM-enriched immunoglobulin (IgMIg) on 30-day mortality and its ability to reverse vasoplegia in patients undergoing LT. Methods Between May 2013 and November 2017, 473 LT were performed at our institution. We identified 21 patients who received IgMIg for 3 days to treat vasoplegia. Patients included in the study met the criteria for having vasoplegia and required noradrenaline administration greater than 1 μg·kg-1·min-1 for more than 24 hours to maintain a mean arterial pressure of 70 mm Hg or greater. Procalcitonin and interleukin-6 (IL-6) levels were used as surrogate markers for inflammation and were measured at the beginning and end of IgM treatment. Results After IgMIg administration, median noradrenaline infusion rates could be significantly reduced from 1.6 μg·kg-1·min-1 (1.3-2 μg·kg-1·min-1) to 0.16 μg·kg-1·min-1 (0.08-0.34 μg·kg-1·min-1) (P < 0.001). In addition, after treatment, procalcitonin levels decreased significantly from 44 ng/mL (24-158) to 26.1 ng/mL (10.9-48.7) (P < 0.001) and IL-6 levels decreased significantly from 63 pg/mL (29-102) to 20 pg/mL (11-20) (P < 0.001). Thirty-day morality was 14.3{\%}. Conclusions The administration of IgMIg in patients with vasoplegia after LT is associated with a return of hemodynamic stability. Despite a predicted mortality of over 90{\%} by Sepsis-Related Organ Failure Assessment score, the mortality rate of patients receiving IgMIg in our study was less than 20{\%}.",
author = "Katharina Willuweit and Dmitri Bezinover and Kerstin Herzer and Nowak, {Knut M.} and Andreas Paul and Saner, {Fuat H.}",
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Efficacy of IgM-enriched Immunoglobulin for Vasopressor-resistant Vasoplegic Shock after Liver Transplantation. / Willuweit, Katharina; Bezinover, Dmitri; Herzer, Kerstin; Nowak, Knut M.; Paul, Andreas; Saner, Fuat H.

In: Transplantation, Vol. 103, No. 2, 01.02.2019, p. 381-386.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Efficacy of IgM-enriched Immunoglobulin for Vasopressor-resistant Vasoplegic Shock after Liver Transplantation

AU - Willuweit, Katharina

AU - Bezinover, Dmitri

AU - Herzer, Kerstin

AU - Nowak, Knut M.

AU - Paul, Andreas

AU - Saner, Fuat H.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background Vasoplegia is a clinical condition typically manifested by cardiovascular instability unresponsive to the usual doses of inotropes or vasopressors. It can occur in a variety of clinical settings including liver transplantation (LT). Immunoglobulins have been used to treat sepsis-related vasoplegia. We performed a retrospective study to evaluate the efficacy of IgM-enriched immunoglobulin (IgMIg) on 30-day mortality and its ability to reverse vasoplegia in patients undergoing LT. Methods Between May 2013 and November 2017, 473 LT were performed at our institution. We identified 21 patients who received IgMIg for 3 days to treat vasoplegia. Patients included in the study met the criteria for having vasoplegia and required noradrenaline administration greater than 1 μg·kg-1·min-1 for more than 24 hours to maintain a mean arterial pressure of 70 mm Hg or greater. Procalcitonin and interleukin-6 (IL-6) levels were used as surrogate markers for inflammation and were measured at the beginning and end of IgM treatment. Results After IgMIg administration, median noradrenaline infusion rates could be significantly reduced from 1.6 μg·kg-1·min-1 (1.3-2 μg·kg-1·min-1) to 0.16 μg·kg-1·min-1 (0.08-0.34 μg·kg-1·min-1) (P < 0.001). In addition, after treatment, procalcitonin levels decreased significantly from 44 ng/mL (24-158) to 26.1 ng/mL (10.9-48.7) (P < 0.001) and IL-6 levels decreased significantly from 63 pg/mL (29-102) to 20 pg/mL (11-20) (P < 0.001). Thirty-day morality was 14.3%. Conclusions The administration of IgMIg in patients with vasoplegia after LT is associated with a return of hemodynamic stability. Despite a predicted mortality of over 90% by Sepsis-Related Organ Failure Assessment score, the mortality rate of patients receiving IgMIg in our study was less than 20%.

AB - Background Vasoplegia is a clinical condition typically manifested by cardiovascular instability unresponsive to the usual doses of inotropes or vasopressors. It can occur in a variety of clinical settings including liver transplantation (LT). Immunoglobulins have been used to treat sepsis-related vasoplegia. We performed a retrospective study to evaluate the efficacy of IgM-enriched immunoglobulin (IgMIg) on 30-day mortality and its ability to reverse vasoplegia in patients undergoing LT. Methods Between May 2013 and November 2017, 473 LT were performed at our institution. We identified 21 patients who received IgMIg for 3 days to treat vasoplegia. Patients included in the study met the criteria for having vasoplegia and required noradrenaline administration greater than 1 μg·kg-1·min-1 for more than 24 hours to maintain a mean arterial pressure of 70 mm Hg or greater. Procalcitonin and interleukin-6 (IL-6) levels were used as surrogate markers for inflammation and were measured at the beginning and end of IgM treatment. Results After IgMIg administration, median noradrenaline infusion rates could be significantly reduced from 1.6 μg·kg-1·min-1 (1.3-2 μg·kg-1·min-1) to 0.16 μg·kg-1·min-1 (0.08-0.34 μg·kg-1·min-1) (P < 0.001). In addition, after treatment, procalcitonin levels decreased significantly from 44 ng/mL (24-158) to 26.1 ng/mL (10.9-48.7) (P < 0.001) and IL-6 levels decreased significantly from 63 pg/mL (29-102) to 20 pg/mL (11-20) (P < 0.001). Thirty-day morality was 14.3%. Conclusions The administration of IgMIg in patients with vasoplegia after LT is associated with a return of hemodynamic stability. Despite a predicted mortality of over 90% by Sepsis-Related Organ Failure Assessment score, the mortality rate of patients receiving IgMIg in our study was less than 20%.

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