TREATMENT OF INFECTIONS IN LUNG TRANSPLANT PATIENTS WITH FILGRASTIN (G-CSF) DOES NOT INDUCE REJECTION

Abstract

132 Infections are a significant source of morbidity and mortality in lung transplant patients. Recent studies have shown that granulocyte colony stimulating factor (G-CSF) not only increases the absolute number of neutrophils, but that it also may mediate qualitative improvement of neutrophils by enhancing chemotaxis, phagocytosis and increased release of superoxide anions. However, in the transplant community, there is concern that G-CSF may precipitate allograft rejection due to the upregulation of neutrophil function. We evaluated the risks and benefits of G-CSF in two neutropenic and seven non-neutropenic lung transplant patients with serious infections. The average age of these patients was 45 ± 18 years. Five patients had an underlying diagnosis of cystic fibrosis and four patients had a diagnosis of emphysema for which they underwent lung transplantation. Eight of the patients had pneumonia. The causative organisms included Mucormycosis (1), Aspergillus fumigatus (3), Cytomegalovirus (2) and Burkholderia Cepacia (2). One patient had a central nervous system infection with Aspergillus fumigatus. The average duration of G-CSF administration was 17 ± 13 days. The average absolute neutrophil count was 7,000 ± 8,000/mm3, which increased to 10,000 ± 12,000/mm3 after G-CSF administration. There were no episodes of rejection temporally related to G-CSF administration. Four patients (one neutropenic patient and three non-neutropenic patients) died during G-CSF administration due to overwhelming infection. We conclude that G-CSF does not induce acute rejection in lung transplant patients and may provide added benefit in the treatment of infections. These results suggest that a randomized controlled trial is necessary to assess the benefit of G-CSF in infected non-neutropenic patients and to elucidate the mechanism of this presumed benefit.