Granulocyte colony‐stimulating factor with or without immunosuppression reduction in neutropenic kidney transplant recipients. Issue 9 (29th July 2022)

• Record Type: Journal Article
• Authors: Sandal, Shaifali; Yao, Han; Alam, Ahsan; Arienzo, David D'; Baran, Dana; Cantarovich, Marcelo
• Is Part Of: Clinical transplantation. Volume 36:Issue 9(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-07-29
• Subjects: all‐cause graft failure -- donor‐specific antibody -- granulocyte colony‐stimulating factor -- immunosuppression reduction -- kidney transplantation -- neutropenia; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.14766
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: Introduction: Neutropenia post‐kidney transplantation is associated with adverse graft and patient outcomes. We aimed to analyze the effect of granulocyte colony‐stimulating factor (G‐CSF) use with and without immunosuppression reduction on graft outcomes in neutropenic recipients. Methods: In this retrospective cohort study, we identified 120 recipients with neutropenia, within the first‐year post‐transplant. Results: Of these, 45.0% underwent no intervention, 17.5% had immunosuppression reduced, 18.3% were only given G‐CSF, and 19.2% had both interventions. Overall, 61 patients experienced the composite outcome of de‐novo DSA, biopsy‐proven acute rejection, and all‐cause graft failure and the cumulative incidence of this outcome did not vary by any of the four interventions ( p = .93). When stratifying the cohort by G‐CSF use alone, those who received G‐CSF were more likely to have had severe neutropenia (<500/mm 3 : 51.1% vs. 12.0%, p < .001), and immunosuppression reduction (51.1% vs. 28.0%, p = .003). However, the composite outcome was not different in the G‐CSF and no G‐CSF cohort (53.3% vs. 49.3%, p = .67), and in a multivariate model, G‐CSF use was not associated with this outcome (aHR = 1.18, 95% CI: .61–2.30). However, a trend towards higher DSA production was noted in the G‐CSF cohort (87.5% vs. 62.2%) and this observation warrants prospective evaluation. Conclusion: Overall, we conclude that G‐CSF use with or without immunosuppression reduction was not associated with graft outcomes.