TY - JOUR
T1 - Lung transplant outcomes are influenced by severity of neutropenia and granulocyte colony-stimulating factor treatment
AU - Tague, Laneshia Karee
AU - Scozzi, Davide
AU - Wallendorf, Michael
AU - Gage, Brian F.
AU - Krupnick, Alexander S.
AU - Kreisel, Daniel
AU - Byers, Derek
AU - Hachem, Ramsey R.
AU - Gelman, Andrew E.
N1 - Publisher Copyright:
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2020/1/1
Y1 - 2020/1/1
N2 - 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.
AB - 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.
KW - clinical decision-making
KW - clinical research/practice
KW - complication: infectious
KW - innate immunity
KW - lung transplantation/pulmonology
KW - patient survival
KW - rejection
UR - http://www.scopus.com/inward/record.url?scp=85073990670&partnerID=8YFLogxK
U2 - 10.1111/ajt.15581
DO - 10.1111/ajt.15581
M3 - Article
C2 - 31452317
AN - SCOPUS:85073990670
SN - 1600-6135
VL - 20
SP - 250
EP - 261
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 1
ER -