Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Granulocyte colony stimulating factor (GCSF) is a management strategy for post-transplant neutropenia, but may increase the risk of rejection in lung transplant recipients (LTRs). We sought to assess the incidence of rejection following GCSF administration and characterize the risk factors and management of neutropenia in LTRs.
*Methods: An analysis of all first LTRs from 4/2014-5/2019 at a single center was conducted to determine the incidence of rejection post GCSF administration, incidence and management of neutropenia (defined as ANC <1x109/L), infection incidence, and 1 year graft and patient outcomes.
*Results: 69 LTRs were included; at least 1 episode of neutropenia occurred in 23 (33%) LTRs at a median of 171 days post-transplant, and 18 (26%) received at least 1 dose of GCSF (Table 1). Only one (5.5%) LTR experienced rejection following GCSF administration. Notably, rejection occur more frequently, earlier and with a higher grade in the cohort of LTRs who ultimately required GCSF; no difference in infection or mortality was seen (Table 2). 57 neutropenia episodes occurred with a median duration of 10.5 days and ANC nadir of 0.6. Recurrent neutropenia was common with a median of 2.4 episodes per patient. Neutropenia episodes were managed by decreases to antiviral (61.4%), antimetabolite (38.5%), or both agents (21%) in addition to 72% requiring GCSF administration at a median of 690mcg/episode. While no differences in tacrolimus levels or renal function were seen between the two groups, mean mycophenolate doses were lower in the GCSF cohort by 6 months, while prednisone doses were higher starting at 9 months post-transplant (Table 1).
*Conclusions: In patients with early and recurrent rejection, neutropenia management with medication dose adjustment and GCSF support did not precipitate further episodes of rejection. No patient characteristics including age, weight, baseline laboratory values, and underlying lung disease were predictive of the development of neutropenia.
To cite this abstract in AMA style:Walter K, Patti M, Khalid S, Kemp L, Lobo LJ, Coakley R, Krishnan S, Doligalski CT. Granulocyte Colony Stimulating Factor: Trigger of Rejection in Lung Transplantation? [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/granulocyte-colony-stimulating-factor-trigger-of-rejection-in-lung-transplantation/. Accessed March 6, 2021.
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