Implanted ports in adults with primary immunodeficiency

• Published in: The journal of vascular access 2018-07, Vol.19 (4), p.375-377
• Main Authors: Barton, James C, Barton, Jackson Clayborn, Bertoli, Luigi F
• Format: Article
• Language: English
• Subjects: Adult; Aged; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - instrumentation; Catheters, Indwelling; Central Venous Catheters; Drug Administration Schedule; Equipment Failure; Female; Humans; Immunoglobulin G - administration & dosage; Immunologic Deficiency Syndromes - diagnosis; Immunologic Deficiency Syndromes - drug therapy; Immunologic Deficiency Syndromes - immunology; Immunologic Factors - administration & dosage; Infusions, Intravenous; Male; Middle Aged; Patient Preference; Time Factors; Treatment Outcome
• ISSN: 1129-7298; 1724-6032
• DOI: 10.1177/1129729818757966

Background: We sought to learn more about the utility and safety of implanted ports for monthly immunoglobulin G infusions in adults with primary immune deficiency. Methods: We reviewed charts of adults who were referred to a single practice during the interval 2006–2016 for evaluation and management of frequent or severe upper and lower respiratory tract and other infections, subnormal total immunoglobulin G or immunoglobulin G subclasses, and suboptimal responses to polyvalent pneumococcal polysaccharide vaccinations; were diagnosed to have primary immune deficiency; and were advised to undergo immunoglobulin G therapy. Results: Of 606 patients, 20 (19 women, 1 man; 16 immunoglobulin G subclass deficiency, 4 common variable immunodeficiency; 3.3%) needed implanted ports because they had inadequate upper extremity superficial venous access. Median age at diagnosis was 48 years (range: 32–65 years). In total, 17 of the 20 patients preferred monthly in-office intravenous immunoglobulin G treatment to weekly at-home subcutaneous immunoglobulin G. The other three patients could not be treated with subcutaneous immunoglobulin G (unfavorable self-treatment experiences and insurance limitations). Median duration of treatment via implanted ports was 73 months (range: 10–153 months). In the man, the first implanted port was replaced after 26 months due to catheter fracture of unknown cause. His second port has been used for 112 months. We observed no other port-related failure, infections, thrombosis, or other adverse events. Conclusion: The utility and safety of implanted ports in adults with primary immune deficiency for whom subcutaneous immunoglobulin G therapy is not desired or feasible are probably similar to those of ports in patients without primary immune deficiency.