Premium
Lung transplant outcomes are influenced by severity of neutropenia and granulocyte colony‐stimulating factor treatment
Author(s) -
Tague Laneshia Karee,
Scozzi Davide,
Wallendorf Michael,
Gage Brian F.,
Krupnick Alexander S.,
Kreisel Daniel,
Byers Derek,
Hachem Ramsey R.,
Gelman Andrew E.
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15581
Subject(s) - medicine , neutropenia , hazard ratio , granulocyte colony stimulating factor , proportional hazards model , absolute neutrophil count , confidence interval , propensity score matching , lung transplantation , retrospective cohort study , gastroenterology , transplantation , surgery , chemotherapy
Although neutropenia is a common complication after lung transplant, its relationship with recipient outcomes remains understudied. We evaluated a retrospective cohort of 228 adult lung transplant recipients between 2008 and 2013 to assess the association of neutropenia and granulocyte colony‐stimulating factor ( GCSF ) treatment with outcomes. Neutropenia was categorized as mild (absolute neutrophil count 1000‐1499), moderate (500‐999), or severe (<500) and as a time‐varying continuous variable. Associations with survival, acute rejection, and chronic lung allograft dysfunction ( CLAD ) were assessed with the use of Cox proportional hazards regression. GCSF therapy impact on survival, CLAD , and acute rejection development was analyzed by propensity score matching. Of 228 patients, 101 (42.1%) developed neutropenia. Recipients with severe neutropenia had higher mortality rates than those of recipients with no (adjusted hazard ratio [ aHR ] 2.97, 95% confidence interval [ CI ] 1.05‐8.41, P = .040), mild ( aHR 14.508, 95% CI 1.58‐13.34, P = .018), or moderate ( aHR 3.27, 95% CI 0.89‐12.01, P = .074) neutropenia. Surprisingly, GCSF treatment was associated with a higher risk for CLAD in mildly neutropenic patients ( aHR 3.49, 95% CI 0.93‐13.04, P = .063), although it did decrease death risk in severely neutropenic patients ( aHR 0.24, 95% CI 0.07‐0.88, P = .031). Taken together, our data point to an important relationship between neutropenia severity and GCSF treatment in lung transplant outcomes.