Increase in short-term risk of rejection in heart transplant patients receiving granulocyte colony-stimulating factor

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:37

Article

Nguyen, Ann B.¹  Lourenco, Laura²  Chung, Ben Bow¹  Imamura, Teruhiko¹  Rodgers, Daniel¹  Besser, Stephanie A.¹  Murks, Catherine¹  Riley, Tiana¹  Powers, JoDel¹  Raikhelkar, Jayant¹  Kalantari, Sara¹  Sarswat, Nitasha¹  Jeevanandam, Valluvan³  Kim, Gene¹  Sayer, Gabriel¹  Uriel, Nir¹ 

[1] Univ Chicago Med, Dept Med, Sect Cardiol, 5841 S Maryland Ave,MC 2016, Chicago, IL 60637 USA

[2] Univ Chicago Med, Dept Pharm Serv, Chicago, IL USA

[3] Univ Chicago Med, Dept Surg, Sect Cardiac & Thorac Surg, Chicago, IL USA

关键词: neutropenia;    G-CSF;    acute rejection;    heart transplantation;    immunosuppression;    infection prophylaxis;   

DOI  :  10.1016/j.healun.2018.06.009

来源: Elsevier

【 摘 要 】

BACKGROUND: Neutropenia is a significant adverse event after heart transplantation (HT) and increases infection risk. Granulocyte colony-stimulating factor (G-CSF) is commonly used in patients with neutropenia. In this work, we assessed the adverse effects of G-CSF treatment in the setting of a university hospital. METHODS: Data on HT patients from January 2008 to July 2016 were reviewed. Patients who received G-CSF were identified and compared with patients without a history of therapy. Baseline characteristics, rejection episodes, and outcomes were collected. Data were analyzed by incidence rates, time to rejection and survival were analyzed using Kaplan Meier curves, and odds ratios were generated using logistic regression analysis. RESULTS: Two hundred twenty-two HT patients were studied and 40 (18%) received G-CSF for a total of 85 total neutropenic events (0.79 event/patient year). There were no differences in baseline characteristics between the groups. In the 3 months after G-CSF, the incidence rate of rejection was 0.067 event/month. In all other time periods considered free of G-CSF effect, the incidence rate was 0.011 event/month. This rate was similar to the overall incidence rate in the non-GCSF group, which was 0.010 event/month. There was a significant difference between the incidence rates in the G-CSF group at 0 to 3 months after G-CSF administration and the non-GCSF group (p = 0.04), but not for the other time periods (p = 0.5). Freedom from rejection in the 3 months after G-CSF administration was 87.5% compared with 97.5% in the non-GCSF group (p = 0.006). CONCLUSIONS: G-CSF administration was found to be associated with significant short-term risk of rejection. This suggests the need for increased surveillance during this time period. J Heart Lung Transplant 2018;37:1322-1328 (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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