Lung transplant outcomes are influenced by severity of neutropenia and granulocyte colony-stimulating factor treatment

Laneshia Karee Tague, Davide Scozzi, Michael Wallendorf, Brian F. Gage, Alexander S. Krupnick, Daniel Kreisel, Derek Byers, Ramsey R. Hachem, Andrew E. Gelman

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)250-261
Number of pages12
JournalAmerican Journal of Transplantation
Volume20
Issue number1
DOIs
StatePublished - Jan 1 2020

Keywords

  • clinical decision-making
  • clinical research/practice
  • complication: infectious
  • innate immunity
  • lung transplantation/pulmonology
  • patient survival
  • rejection

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