Efficacy of IgM-Enriched Immunoglobulin for Vasopressor-Resistant Vasoplegic Shock After Liver Transplantation

Background Vasoplegia is a clinical condition typically manifested by cardiovascular instability unresponsive to 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 5/2013 and 11/2017, 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/min for more than 24 h to maintain a mean arterial pressure (MAP) ≥ 70 mmHg. Procalcitonin (PCT) 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 (1.3-2) μg/kg/min to 0.16 (0.08-0.34) μg/kg/min (P

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