Factors Associated with Neutropenia Post-Heart Transplantation

Abstract

<h3>Purpose</h3> Neutropenia is a serious complication following heart transplantation (OHT) however risk factors for its development and its association with outcomes is not well described. We sought to study the prevalence of neutropenia, risk factors associated with its development and its impact on infection, rejection and survival. <h3>Methods</h3> A retrospective single center analysis of adult OHT recipients from July 2004 to December 2017 was performed. Demographic, laboratory, medication, infection, rejection and survival data were collected for 1 year post-OHT. Baseline lab measurements were collected within the 24 hours before OHT. Neutropenia was defined as absolute neutrophil count ≤ 1000 mm3. Cox proportional hazards models explored associations with time to first neutropenia. Associations of neutropenia, analyzed as a time-dependent covariate, with secondary outcomes of time to infection, rejection or death were also examined. <h3>Results</h3> Of 278 OHT recipients, 84 (30%) developed neutropenia within a median of 142 days (81-228 days) after transplant. More than half (56%) of those with neutropenia were treated with GCSF. Most infections were CMV disease whether they occurred before (14/22, 64%) or after (8/9, 89%) neutropenia or in the absence of neutropenia (20/40, 50%). Factors associated with increased risk of neutropenia are in Table 1. Neutropenia was not significantly associated with secondary outcomes of infection (N=9), rejection (N=10) or death (N=4), however numbers were small. <h3>Conclusion</h3> Neutropenia is a fairly common occurrence after adult OHT. Infection was associated with subsequent neutropenia, however no statistically significant differences in outcomes (infection, rejection, death) were found between neutropenic and non-neutropenic patients in this small study. It remains to be determined if medication changes in response to neutropenia impact patient outcomes. Supported by an unrestricted grant by Merck, NIH CTSA award: UL1TR002544 and Tupper Research Fund at Tufts Medical Center.