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ID PMID Title PublicationDate abstract
24126397 Primary Sjögren syndrome presenting with hemolytic anemia and pure red cell aplasia follo 2013 A 36-year-old woman presented with hemolytic anemia without a reticulocyte response 38 days after delivery. A marked reduction in erythroid cells and an increase in macrophages with active hemophagocytosis were noted in the bone marrow. While conventional Coombs' tests were negative, the level of red blood cell (RBC)-bound immunoglobulin G (IgG) was increased. The patient was diagnosed with primary Sjögren syndrome (pSS) based on her symptoms, positive anti-SS-A antibodies, Coombs-negative autoimmune hemolytic anemia and pure red cell aplasia associated with RBC-bound IgG and hemophagocytosis. The unique presentation was considered to be a consequence of immunological derangement associated with pSS, pregnancy and delivery.
25606596 Immune checkpoint receptors in regulating immune reactivity in rheumatic disease. 2014 Immune checkpoint regulators are critical modulators of the immune system, allowing the initiation of a productive immune response and preventing the onset of autoimmunity. Co-inhibitory and co-stimulatory immune checkpoint receptors are required for full T-cell activation and effector functions such as the production of cytokines. In autoimmune rheumatic diseases, impaired tolerance leads to the development of diseases such as rheumatoid arthritis, systemic lupus erythematosus, and Sjogren's syndrome. Targeting the pathways of the inhibitory immune checkpoint molecules CD152 (cytotoxic T lymphocyte antigen-4) and CD279 (programmed death-1) in cancer shows robust anti-tumor responses and tumor regression. This observation suggests that, in autoimmune diseases, the converse strategy of engaging these molecules may alleviate inflammation owing to the success of abatacept (CD152-Ig) in rheumatoid arthritis patients. We review the preclinical and clinical developments in targeting immune checkpoint regulators in rheumatic disease.
23981123 Liver transplantation for acute liver failure caused by macrophage activation syndrome. 2013 Nov Macrophage activation syndrome (MAS) is a rare, potentially fatal condition, which most frequently complicates rheumatological conditions and is often associated with liver dysfunction. In this case report of a patient with MAS, acute liver failure developed despite conventional immunosuppressive therapy. Liver transplantation resulted in rapid recovery and the patient has remained well for six years. A recent diagnosis of Adult Onset Still's Disease (AOSD) provides additional supporting evidence that the initial presentation was caused by MAS. While transplantation in the context of systemic disease remains controversial, this first reported case of successful adult liver transplantation for acute liver failure caused by MAS raises an interesting clinical dilemma.
24890774 Imaging: diagnostic value of ultrasonography in Sjögren's syndrome. 2014 Aug Salivary gland ultrasonography is a promising tool for the evaluation of Sjögren’s syndrome. Cumulative data suggest that ultrasonography is comparable with older imaging modalities such as sialography and scintigraphy. However, certain issues remain to be addressed before it can be integrated into current or future classification systems.
22858451 Factors influencing discrepancies between the QuantiFERON-TB gold in tube test and the tub 2013 Feb OBJECTIVES: To estimate the positivity and agreement between QuantiFERON-tuberculosis (TB) gold in tube test (QFT-GIT) and tuberculin skin test (TST) according to underlying rheumatic diseases and to identify the influencing factors on discrepancies between the 2 tests. METHODS: Among the 757 patients who underwent both QFT-GIT and TST simultaneously from September 2008 to November 2010, patients with indeterminate QFT-GIT results (n = 21), with active (n = 11) or suspicious (n = 1) findings for tuberculosis on a chest radiograph, were excluded. Finally, 724 patients were recruited for this study: 497 patients with rheumatoid arthritis (RA), 198 with ankylosing spondylitis (AS), and 29 with juvenile rheumatoid arthritis (JRA). The agreement between the 2 tests was estimated by Cohen's κ and factors influencing discrepancies were identified using multivariate analysis. RESULTS: The positivity of QFT-GIT was higher in RA than AS or JRA (30.2%, 16.2%, and 3.4%, respectively). In contrast, TST positivity was highest in AS compared to RA and JRA (45.5%, 28.2%, and 17.2%, respectively). The agreement between the 2 tests was low in all patients (κ = 0.285). The only predictor of a discrepancy between the 2 tests was older age. Factors associated with discordant QFT-GIT-negative/TST-positive results were female [odds ratio (OR) = 2.33, confidence interval (CI) 1.11 to 4.89] and AS (OR = 3.12, CI 1.44 to 6.79), whereas a discordant QFT-GIT-positive/TST-negative result was associated with glucocorticoid use (OR = 2.44, CI 1.24 to 4.81). CONCLUSIONS: The agreement between the 2 tests is low; therefore, it would be better to perform both tests than to use any 1 test alone for the detection of LTBI in TB-endemic regions. Female and underlying AS are related to being QFT-GIT-negative/TST-positive, and the use of glucocorticoid is associated with being QFT-GIT-positive/TST-negative.
23506002 New selective inhibitors of MMP-13 for inflammatory diseases: a patent evaluation (W020121 2013 May A series of compounds incorporating an aromatic scaffold based on isoxazolines were prepared in the patent application (WO2012151158). The new compounds from the patent are defined to be biologically active metabolites, prodrugs, isomers, stereoisomers, solvates, hydrates and pharmaceutically acceptable salts, they are claimed to be useful for treating immunological conditions because of their inhibitory activities on matrix metalloproteinase (MMP-13), although no specific MMP-13 inhibition data or other rationale to explain their biological effects is provided. The compounds have a broad potential utility with osteoarthritis, rheumatoid arthritis, juvenile arthritis, psoriatic arthritis, degenerative joint disease or systemic lupus erythematosus among the likely preferred indications.
24893240 Neurologic complications of rheumatic disease. 2014 Jun PURPOSE OF REVIEW: This article discusses the specific neurologic issues that arise in patients with rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus, and Sjögren syndrome. Diagnosis and management are discussed. RECENT FINDINGS: Advances include advanced imaging, serologic and CSF markers, and targeted immune-modulating therapies. The use of these modalities are discussed in detail. SUMMARY: Rheumatic disorders are quite common and can result in disabling but many times treatable neurologic sequelae. The key is early diagnosis and management. Awareness of the common presentations and current modalities of diagnosis and treatment is critical to improved outcomes.
23429017 Cryofibrinogenaemia: not just skin deep. 2013 Feb 20 A Caucasian woman in her 60s with a history of rheumatoid arthritis presented to our institution complaining of skin ulceration. Her initial course was complicated by superinfection and sepsis until a diagnosis of cryofibrinogenaemia was finally established. Cryofibrinogenaemia remains as an under-recognised entity in part, because it can mimic other causes of skin ulcerations. In addition, its diagnosis can be challenging because of the particular handling techniques required of lab specimens. This case exemplifies some of the diagnostic and treatment challenges encountered while managing the patient with cryofibrinogenaemia.
23199057 Did Rubens' Delilah have Mondor's disease? 2013 Mar BACKGROUND: Rubens was a master of European Baroque painting and a practitioner of realism. A female model for his paintings of Samson and Delilah and the Three Graces has apparent right-sided breast abnormalities. METHOD AND RESULTS: Examination of the images shows persistent changes. The clinical scenario suggests Mondor's disease, possibly related to rheumatoid arthritis or chronic infection. DISCUSSION: Visible breast changes such as distortion, skin retraction and nipple deviation warrant concern and require investigation.
26461394 Lipid peroxidation in Rheumatoid arthritis; consequences and monitoring. 2014 Oct The epidemiological studies have shown that rheumatoid arthritis (RA) leads to oxidative stress formation. Therefore the aim of this study has been to estimate the lipid peroxidation in RA patients. Moreover the reasons and consequences of changes in lipid peroxidation were estimated. 73 patients with RA and 62 healthy subjects were included into the study. Lipid peroxidation was estimated by the measurement of phospholipid arachidonic acid (AA) and linoleic acid (LA) as well as aldehydes: 4-hydroxynonenal (4-HNE), 4-hydroxyhexenal (4-HHE), malondialdehyde (MDA), acrolein, crotonaldehyde, and 4-oxononenal (4-ONE) that were determined by GC and GCMS, while 8-isoprostanes (8-isoPGF2a) - was determined by LCMS. Phospholipase A2 (PLA2), platelet-activating factor acetylhydrolase (PAF-AH) and glutathione peroxidase (GSH-Px) activity were determined spectrophotometrically, while vitamin E was determined by HPLC. Plasma of RA patients was characterized by higher vitamin E level and decreased GSH-Px activity as well as the level of phospholipid AA and LA compared to healthy subjects. The level of all examined aldehydes was significantly increased in plasma patients but higher increase was observed in urine of RA patients in comparison with control group. The 8-isoprostanes level was approximately 9-fold higher in the plasma and 3-fold higher in the urine of RA patients compared to healthy subjects, but in the urine the changes in 8-isoprostanes level was correlated with RA progression. A significant increase in 4-HNE-modified protein adducts level as well as a decrease in the activity of PAF-AH and PLA2 were observed in the plasma of RA patients. The level of lipid peroxidation products in the plasma and the urine may be the indicator of RA, but additionally urine 8-isoprostanes may be the useful and reliable biomarker of RA progression.
26208932 Biologic TNF inhibiting agents for treatment of rheumatoid arthritis: persistence and dosi 2014 Dec OBJECTIVE: To obtain detailed real-world data on persistence and dosing patterns in the utilisation of the TNF inhibitors adalimumab, etanercept, and infliximab in rheumatoid arthritis (RA) patients treated in Germany. METHODS: In this retrospective observational study claims data of a major German health insurance fund between 2005 and 2008 were analysed. Patients receiving at least one prescription of adalimumab, etanercept or infliximab were identified and categorised as "TNF inhibitor naive" or "TNF inhibitor continuing". For the calculation of TNF inhibitor persistence a survival analysis with the Kaplan-Meier estimator was used. A Cox regression was used to analyse, if any relevant factors were influencing persistence. Dosage increase rates were analysed for adalimumab, etanercept and infliximab. Sensitivity analyses based on variations in gap length were conducted. RESULTS: A total of 2,201 RA patients were identified. 1,468 of these patients were TNF inhibitor naive patients and 733 were defined as TNF inhibitor continuing patients. There were no significant differences in the treatment persistence rates between adalimumab, etanercept and infliximab for TNF inhibitor naive and continuing patients. The persistence rate after three years was 22.47% for adalimumab, 24.27% for etanercept and 21.49% for infliximab naive patients. For continuing patients, the persistence rate after three years was 32.88% for adalimumab, 30.95% for etanercept, and 33.90% for infliximab, respectively. Gender, medication and Charlson Comorbidities Index did not influence the persistence significantly. Dosage increase occurred in 7.3% adalimumab, 1.4% etanercept, and 17.2% infliximab naive patients and 5.8%, 1.1% and 11.9% respectively in the continuing patients. CONCLUSIONS: In this study, there were no significant differences in persistence among adalimumab, etanercept and infliximab treated patients. Consistent with previous research, there was a higher dose escalation for infliximab than for the two subcutaneous treatments, adalimumab or etanercept.
25463887 The use of musculoskeletal ultrasound in a rheumatology outpatient clinic. 2014 Dec INTRODUCTION: Musculoskeletal ultrasound (US) represents a valid, reliable and sensitive-to-change tool for the evaluation of patients suffering from rheumatic conditions. This method demonstrates a wide applicability and availability, finding place in the clinical practice in rheumatology outpatient clinic. AIM: To perform an epidemiological evaluation related to the use of US in a university rheumatology outpatient clinic. MATERIAL AND METHODS: During a 3-month period, data concerning consecutive patients attending to the US Unit of Department of Rheumatology, Sapienza University of Rome were registered. We collected the demographic data, the diagnosis, the reason for the US examination, the examined joints, as well as the requesting physicians' specialty. RESULTS: In the period October-December 2013, 572 patients (M/F 137/435; mean age+/-SD 55.2+/-15.8 years) were registered. The US examination was more frequently requested for the following diseases: rheumatoid arthritis (29.5%), osteoarthritis (10.6%), spondyloarthritis (9.1%), and connective tissue diseases (8.9%). In 239 of cases (41.8%), the US evaluation was requested for other indications. The US evaluation was requested slightly more frequently for monitoring (55.7%) compared to diagnosis (44.3%). The requesting physician was a rheumatologist in the majority of the cases (80.6%). The most frequent requested were the hand joints (28.9%) and wrists (23.3%). CONCLUSIONS: US examinations are most frequently used in the evaluation of patients with rheumatoid arthritis and mainly to monitor the disease. The exam is requested mostly by rheumatologists. The hand joints and wrists were the most frequently evaluated.
24548600 The prevalence of gout in an urban area of Izmir, Turkey: a population-based epidemiologic 2014 Jun OBJECTIVES: This study aimed to determine the prevalence of gout in a general Turkish population, according to the American College of Rheumatology (Wallace) criteria proposed for gout classification. METHODS: This study was conducted in two districts of Izmir Province in Turkey, and involved 2835 subjects of ≥ 20 years of age. In the first stage, face-to-face interviews were performed at the subjects' registered households. In the second stage, subjects who gave positive answers in the screening questionnaire were invited to the hospital for a full examination, which included a detailed medical history, medication use and blood tests. RESULTS: A total of 2887 subjects were contacted, and complete interviews were obtained for 2835 (1551 women, 1284 men). A total of 312 subjects (227 women, 85 men) reported experiencing a short period of joint pain accompanied by swelling, redness or reduced range of movement, and 247 (79%) of these patients underwent a detailed clinical examination in the hospital. Gout was diagnosed in 11 patients (8 men, 3 women). We found minimum age- and sex-adjusted prevalence rates of gout of 0.31% (95% CI: 0.16-0.61) in subjects of ≥ 20 years of age, and 0.72% (95% CI: 0.37-1.24) in subjects of ≥ 40 years of age. CONCLUSIONS: Our data suggest that the estimated prevalence of gout (0.31%) is lower than the previously published estimated prevalence of rheumatoid arthritis (0.36%) in the same study population (14 definite rheumatoid arthritis cases among the 2835 subjects).
24462645 Unmet needs in the treatment of autoimmunity: from aspirin to stem cells. 2014 Apr As rheumatologic diseases became understood to be autoimmune in nature, the drugs used to treat this group of conditions has evolved from herbal or plant derived anti-inflammatory agents, such as salicylates, quinine and colchicine to the many recently approved biological response modifiers. These new drugs, especially the anti-tumor necrosis factor agents, have shown remarkable efficacy in autoimmune diseases, and there are new agents under investigation that will provide additional treatment options. In between, the world was introduced to cortisone and all of its derivatives, as chemical synthesis led to better, more efficacious drugs with lesser side effects. Disease modifying anti-rheumatic agents have actually been around since the first half of the 20th century, but only began to be used in the treatment of autoimmune diseases in the 1970s and 1980s. One advantage is that they have been invaluable in their ability to offer "steroid sparing" to decrease the adverse effects of steroids. Research over the past decade has resulted in a new class of drugs that influence cytokine regulatory pathways such as the Janus associated kinase inhibitors. The promise of personalized medicine now permeates current research into new pharmacological agents for the treatment of autoimmune disease. The new appreciation for the gene-environment interaction in the pathogenesis of most diseases especially those as heterogeneous as autoimmune diseases, has led to our focus on targeted therapies. Add to that the new knowledge of epigenetics and how changes in DNA and histone structure affect expression of genes that can play a role in immune signaling, and we now have a new exciting frontier for cutting edge drug development. The history of treatment of autoimmune diseases is really only a little over a century, but so much has changed, leading to increasing lifespans and improved quality of life of those who suffer from these ailments.
24222306 Corneal staining characteristics in limited zones compared with whole cornea documentation 2013 Dec 9 PURPOSE: To determine the reliability of single- and double-zone corneal fluorescent staining compared with five-zone analysis for the prediction of dry eye disease. METHODS: Prospective study of 510 subjects with dry eye disease characterized using corneal fluorescein staining, Schirmer scores, and tear break-up times. Corneal staining was quantified using Baylor scoring with ROC analysis used to assess predictive power of single- and double-zone compared with five-zone analysis for aqueous, evaporative, and mixed dry eye disease. RESULTS: Double-zone analysis predicted each subtype of dry eye disease investigated. Aqueous disease was predicted by superior/inferior zones (AUCSup/Inf 0.797 versus AUCTotal 0.816), evaporative disease by inferior/central zones (AUCInf/Cen 0.759 versus AUCTotal 0.778), and mixed disease by superior/inferior, inferior/nasal, and inferior/central zones (AUCSup/Inf 0.765, AUCInf/Nas 0.771, AUCInf/Cen 0.778 versus AUCTotal 0.795). Inferior zone analysis predicted aqueous (AUCInf 0.751 versus AUCTotal 0.750), evaporative (AUCInf 0.756 versus AUCTotal 0.752), and mixed (AUCInf 0.831 versus AUCTotal 0.788) dry eye disease with similar efficacy to complete analysis in diabetic individuals. Inferior zone analysis also predicted aqueous disease in rheumatoid arthritis patients (AUCInf 0.804 versus AUCTotal 0.785), whereas superior zone analysis predicted evaporative disease in thyroid disease patients (AUCSup 0.765 versus AUCTotal 0.752). CONCLUSIONS: Double-zone corneal staining predicts the presence of dry eye disease with predictive power similar to complete corneal analysis. Additionally, subtypes of dry eye can be predicted by single-zone analysis among patients with diabetes (inferior zone), rheumatoid arthritis (inferior zone), and thyroid disease (superior zone). Clinical characterization of dry eye can thus be hastened by limiting corneal examination to specific zones.
23563508 Remission in patients with active rheumatoid arthritis by tocilizumab treatment in routine 2013 Apr 8 OBJECTIVES: This study aimed to evaluate the remission in rheumatoid arthritis (RA) patients treated with tocilizumab (TCZ), based on prospectively registered data in clinical practice. METHODS: We studied 114 consecutive RA patients treated with TCZ for an average of 3.5 years. Remission was evaluated by using the EULAR criteria and the new ACR/EULAR Boolean-based criteria. RESULTS: Among 114 patients (average age 52.2 years; average disease duration 10.6 years), 76 (67 %) had previously received anti-TNF biologics. Mean baseline DAS28-ESR of 5.4 and improved to 2.4 at 36 months. Overall, DAS28-ESR <2.6 was attained by 66.7 %, while ACR/EULAR remission was attained by 35.1 %. ACR/EULAR remission rate was significantly higher in the patients who were biologics-naïve and had good response at the first month. Among 23 patients who completed the treatment for 3 years and had ACR/EULAR remission at 1 year, 15 (65 %) remained in the remission and 16 (70 %) had a DAS28-ESR <2.6 at the final follow-up. The retention rate at 36 months was 68.2 %. CONCLUSIONS: In patients with RA, TCZ is highly effective for both biologics-naïve patients and patients previously exposed to biologics, achieving a high remission rate and drug continuation rate (68.2 %) in clinical practice.
23380181 Falsely elevated serum antimüllerian hormone level in a context of heterophilic interfere 2013 May OBJECTIVE: To describe a case of falsely elevated serum antimüllerian hormone (AMH) level in an infertile 37-year-old woman with rheumatoid arthritis. DESIGN: Case report. SETTING: Lille University IVF center. PATIENT(S): A 37-year-old woman with rheumatoid arthritis demonstrating a high serum AMH level (74.5 ng/mL) and a low antral follicle count. INTERVENTION(S): Assay with a Heterophilic Blocking Tube (HBT) to avoid heterophilic interference. MAIN OUTCOME MEASURE(S): Serum AMH level, ultrasound antral follicle count, hormonal assays on the 4th day of a spontaneous cycle. RESULT(S): The results of the infertility workup were as follows: serum AMH: 74.5 ng/mL (15-fold the upper limit of normal) (immunoassay: Immunotech); LH: 3.2 IU/L; FSH: 4.5 IU/L; E2: 27 pg/mL; PRL: 10 ng/mL. The antral follicle count (follicles from 2 to 9 mm) at ultrasound was 7 for both ovaries. Because there were discrepancies between the serum AMH level and the results of the infertility workup using the bioassays, we suspected a case of falsely elevated AMH level due to heterophilic interference. An HBT tube revealed a serum AMH level of 0.63 ng/mL. CONCLUSION(S): This case illustrates, for the first time, the possibility of a falsely high serum AMH level due to heterophilic interference.
24491163 Acute murine antigen-induced arthritis is not affected by disruption of osteoblastic gluco 2014 Feb 3 BACKGROUND: The role of endogenous glucocorticoids (GC) in the initiation and maintenance of rheumatoid arthritis (RA) remains unclear. We demonstrated previously that disruption of GC signalling in osteoblasts results in a profound attenuation of K/BxN serum-induced arthritis, a mouse model of RA. To determine whether or not the modulation of the inflammatory response by osteoblasts involves T cells, we studied the effects of disrupted osteoblastic GC-signalling in the T cell-dependent model of antigen-induced arthritis (AIA). METHODS: Acute arthritis was induced in pre-immunised 11-week-old male 11β-hydroxysteroid dehydrogenase type 2 transgenic (tg) mice and their wild-type (WT) littermates by intra-articular injection of methylated bovine serum albumine (mBSA) into one knee joint. Knee diameter was measured every 1-2 days until euthanasia on day 14 post injection. In a separate experiment, arthritis was maintained for 28 days by weekly reinjections of mBSA. Tissues were analysed by histology, histomorphometry and microfocal-computed tomography. Serum cytokines levels were determined by multiplex suspension array. RESULTS: In both short and long term experiments, arthritis developed in tg and WT mice with no significant difference between both groups. Histological indices of inflammation, cartilage damage and bone erosion were similar in tg and WT mice. Bone volume and turnover at the contralateral tibia and systemic cytokine levels were not different. CONCLUSIONS: Acute murine AIA is not affected by a disruption in osteoblastic GC signalling. These data indicate that osteoblasts do not modulate the T cell-mediated inflammatory response via a GC-dependent pathway.
25125973 Subcutaneously administered methotrexate for rheumatoid arthritis, by prefilled syringes v 2014 PURPOSE: This multicenter, randomized, crossover study compared preference, ease of use, acceptability, satisfaction, and safety of repeated subcutaneous (SC) self-administrations with prefilled pens and prefilled syringes delivering methotrexate (MTX), in patients with rheumatoid arthritis (RA). PATIENTS AND METHODS: The study (ClinicalTrials.gov number NCT01793259) enrolled 120 patients requiring initiation or intensification of MTX therapy for RA. Patients were randomized to receive the test drug, a prefilled pen (Metex(®) PEN/Metoject(®) PEN), or the reference drug, a prefilled syringe (Metex(®)/Metoject(®)), at doses of 15, 17.5, or 20 mg MTX SC once a week for 3 weeks. This was followed by receipt of the reference drug (prefilled syringe) or the test drug (prefilled pen) in a crossover design, with each patient serving as his/her own control. Questionnaires regarding patient preference, the Self-Injection Assessment Questionnaire (SIAQ), and diaries regarding local tolerability were used to document outcomes. RESULTS: Overall patient preference for the MTX prefilled pen was 75% (P<0.0001). In a six-item questionnaire, 73% to 76% of the patients preferred the prefilled pen in relation to use, acceptability, and satisfaction, and 67% of the patients confirmed that it did not take much effort to overcome SC self-injection with the pen. The SIAQ showed no clinical differences, in any domain scores, between both devices. Overall patient attitude towards self-injection at baseline was positive, as was patient experience with both devices during the study. As well, 92% of physicians and study nurses indicated that they would recommend the MTX prefilled pen to patients for future MTX treatment. The formulations were generally well tolerated. CONCLUSION: SC self-injection of MTX with a prefilled pen was generally preferred, by patients with RA, over a prefilled syringe with regard to use, acceptability, and satisfaction. This is supported by the strong appreciation of their attending study nurses and physicians, for its convenience.
24802006 Genetic variation in immunoglobulin G receptor affects survival after lung transplantation 2014 Jul Chronic rejection remains the most important complication after lung transplantation (LTx). There is mounting evidence that both rheumatoid arthritis and chronic rejection share similar inflammatory mechanisms. As genetic variants in the FCGR2A gene that encodes the immunoglobulin gamma receptor (IgGR) have been identified in rheumatoid arthritis, we investigated the relationship between a genetic variant in the IgGR gene and chronic rejection and mortality after LTx. Recipient DNA from blood or explant lung tissue of 418 LTx recipients was evaluated for the IgGR (rs12746613) polymorphism. Multivariate analysis was carried out, correcting for several co-variants. In total, 216 patients had the CC-genotype (52%), 137 had the CT-genotype (33%) and 65 had the TT-genotype (15%). Univariate analysis demonstrated higher mortality in the TT-genotype compared with both other genotypes (p < 0.0001). Multivariate analysis showed that the TT-genotype had worse survival compared with the CC-genotype (hazard ratio [HR] = 2.26, p = 0.0002) but no significance was observed in the CT-genotype (HR = 1.32, p = 0.18). No difference was seen for chronic rejection. The TT-genotype demonstrated more respiratory infections (total, p = 0.037; per patient, p = 0.0022) compared with the other genotypes. A genetic variant in the IgGR is associated with higher mortality and more respiratory infections, although not with increased prevalence of chronic rejection, after LTx.