*Purpose: Neutropenia, defined as an absolute neutrophil count (ANC) <1500/mm³, is a frequent complication in kidney transplant recipients (KTR), and this has been linked to acute rejection and mortality. Poor outcomes may be related to a decrease in maintenance immunosuppression (IS). Granulocyte colony stimulating factor (GCSF) can be used to stimulate neutrophil production. Our objective was to determine if use of GCSF is associated with inferior clinical outcomes in neutropenic KTR.

*Methods: We performed a single centre retrospective cohort study of KTR from September 1, 2011 to December 31, 2016 with ANC <1500/mm³. Multi-organ transplants, re-transplants, and recipients with a history of HIV, and primary non-function were excluded. We fit multivariable models to compare the incidence of the primary outcome (composite of donor specific antibodies, acute rejection, graft failure and death), and secondary outcomes (acute rejection, graft failure and death) in neutropenic KTR within 1 year post-neutropenia treated or not with GCSF.

*Results: Of the 549 KTR, 120 developed clinically significant neutropenia. 45 of these patients received GCSF. Overall, baseline characteristics were similar between groups, however the GCSF group had more severe neutropenia (nadir ANC <500/mm³, p<0.001) and more IS reduction (p<0.001). The adjusted hazard ratio (aHR) for the primary composite outcome was 1.00, 95% confidence interval (CI): 0.60-1.18 and 1.18, 95% CI: 0.61-2.30 in univariate and multivariate analysis, respectively. The aHR for the secondary composite outcome was 0.42 (95% CI 0.13 - 1.33)

*Conclusions: In this single centre, observational study, use of GCSF in neutropenic KTR did not have an impact on clinical outcomes. A prospective trial examining the effect of administering GCSF while maintaining stable doses of IS vs. decreasing IS alone is needed to determine the optimal strategy for neutropenic KTR.

« Back to 2019 American Transplant Congress