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

Abstract

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.

• Authors: Ann B Nguyen, Laura Lourenço, Ben Bow Chung, Teruhiko Imamura, Daniel Rodgers, Stephanie A Besser, Catherine Murks, Tiana Riley, JoDel Powers, Jayant Raikhelkar, Sara Kalantari, Nitasha Sarswat, Valluvan Jeevanandam, Gene Kim, Gabriel Sayer, Nir Uriel
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 37 Issue 11 Pg. 1322-1328 (11 2018) ISSN: 1557-3117 [Electronic] United States
• PMID: 30174163 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Granulocyte Colony-Stimulating Factor

Topics

• Female
• Graft Rejection (chemically induced)
• Granulocyte Colony-Stimulating Factor (adverse effects, therapeutic use)
• Heart Transplantation
• Hospitals, University
• Humans
• Male
• Middle Aged
• Neutropenia (drug therapy)
• Risk