Outcomes of Granulocyte-Colony Stimulating Factor Use in Pediatric Renal Transplant Recipients: A Pediatric Nephrology Research Consortium Study

R. M. Engen¹, P. L. Weng², W. Shih³, H. Patel⁴, K. Richardson⁵, S. Dowdrick⁶, I. Ashoor⁷, J. Misurac⁸, A. Z. Traum⁹, M. Semanik¹⁰, N. G. Jain¹¹, R. Sreedharan¹²

¹Northwestern University, Chicago, IL, ²University of California Los Angeles, Los Angeles, CA, ³University of Michigan, Ann Arbor, MI, ⁴Nationwide Children's Hospital, Columbus, OH, ⁵Oregon Health & Science University, Portland, OR, ⁶Penn State Health, Hershey, PA, ⁷Louisiana State University, New Orleans, LA, ⁸University of Iowa, Iowa City, IA, ⁹Harvard University, Boston, MA, ¹⁰University of Wisconsin-Madison, Madison, WI, ¹¹Columbia University, New York, NY, ¹²Medical College of Wisconsin, Milwaukee, WI

Meeting: 2021 American Transplant Congress

Abstract number: 1009

Keywords: Adverse effects, Kidney, Neutropenia, Pediatric

Topic: Clinical Science » Kidney » Kidney: Pediatrics

Session Information

Session Name: Kidney: Pediatrics

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Neutropenia is common after pediatric kidney transplant and is associated with an increased risk of bacterial infection, allograft loss, and death. Granulocyte colony-stimulating factor (G-CSF) increases neutrophil production, but its use in pediatric solid organ transplant recipients remains largely undescribed.

*Methods: Multicenter retrospective cohort study of pediatric renal transplant recipients with neutropenia, defined as absolute neutrophil count (ANC) <1500/mm³ within 6 months after transplant. Multivariable linear regression compared outcomes between those who did and did not receive G-CSF.

*Results: Of 341 neutropenic pediatric renal transplant recipients from 13 centers, 94 (27.6%) received at least one course of G-CSF. Median G-CSF dose was 5 mcg/kg for 3 (IQR 2-7) doses. G-CSF was given to 83 patients during their first episode of neutropenia while 11 were treated for recurrent neutropenia. Median time from neutropenia onset to G-CSF initiation was 7 days (IQR 2-16 days). Treatment with G-CSF was associated with transplant center, induction immunosuppression, steroid-free maintenance immunosuppression, ANC nadir, hospitalization, and decreases in mycophenolate mofetil and valganciclovir doses but was not associated with patient age or CMV or EBV viremia. While G-CSF was associated with a shorter duration of a neutropenia episode (p=0.026), there was a higher rate of recurrent neutropenia following G-CSF discontinuation (p=0.004). Total duration of neutropenia did not differ when the first and second episodes were combined (p=0.817). G-CSF was not associated with decreased bacterial infections, duration of hospitalization, incidence of rejection within 3 months of neutropenia, or increased eGFR at 1 year post-transplant.

*Conclusions: G-CSF does not shorten the overall duration of neutropenia in pediatric kidney transplant recipients and is not associated with decreased rejection or improved eGFR. Additional studies are needed to determine which subset of transplant recipients would benefit from G-CSF treatment.

To cite this abstract in AMA style:

Engen RM, Weng PL, Shih W, Patel H, Richardson K, Dowdrick S, Ashoor I, Misurac J, Traum AZ, Semanik M, Jain NG, Sreedharan R. Outcomes of Granulocyte-Colony Stimulating Factor Use in Pediatric Renal Transplant Recipients: A Pediatric Nephrology Research Consortium Study [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-granulocyte-colony-stimulating-factor-use-in-pediatric-renal-transplant-recipients-a-pediatric-nephrology-research-consortium-study/. Accessed November 25, 2024.

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