Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Neutropenia occurs in up to 40% of kidney and liver transplant (txp) recipients and has been associated with higher mortality rates in liver txp. Limited literature exists concerning management of neutropenia. While filgrastim is commonly used post-txp, it is not approved in solid organ transplant (SOT). The purpose of this study was to evaluate the use of filgrastim in SOT recipients in both the inpatient and outpatient setting.
*Methods: A retrospective, single-center, medication use evaluation was completed for all SOT recipients who received filgrastim from July 2016 to June 2018. Patients were excluded if they received a heart or lung txp or were diagnosed with graft versus host disease. Our institution has a protocol to address neutropenia in kidney txp patients that received alemtuzumab (ALM), but neutropenia management in patients who received alternative induction agents, or who are liver txp is at the physician’s discretion. We evaluated baseline characteristics, medication changes, filgrastim dosing, white blood cell (WBC) and absolute neutrophil count (ANC) values before and after filgrastim administration.
*Results: A total of 152 doses in 63 patients were given inpatient (n=124) and outpatient (n=28) during this time period. Transplant dates ranged from October 1992 to March 2018. More kidney txp recipients (n=29, 46%) received filgrastim; however liver txp recipients (n=21, 33.3%) required more total doses (55 vs 60 doses, 36.2% vs 39.5%, respectively). Multi-organ txp recipients (n=13) comprised 24.3% (n=37) of total doses. An average of 2+1.6 doses were given at the discretion of the physician per episode of leukopenia. Of those who received ALM, only 3 patients received filgrastim. The average WBC on day of first administration was 1.25+0.65 K/µL and the average ANC was 0.89+0.44 K/µL. Seven ±3 days after the last dose of filgrastim, the average WBC was 4.17 + 2 K/µL and the average ANC was 3.47+2.35 K/µL. Filgrastim was given in 22% of patients whose WBC was > 1.5 K/µL and in 38% whose ANC was > 1.0 K/µL. Immunosuppression dose adjustments were at the physician’s discretion and 28% of all patients received an adjustment.
*Conclusions: Filgrastim was successful in treating neutropenia in SOT recipients; however, it may be overused. Transplant specific administration guidelines should be developed to decrease overutilization of filgrastim.
To cite this abstract in AMA style:Witkowsky O, Stanz L, Schnelle K. Filgrastim Utilization Evaluation in Solid Organ Transplant Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/filgrastim-utilization-evaluation-in-solid-organ-transplant-recipients/. Accessed September 26, 2021.
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