Use of Granulocyte Colony-Stimulating Factor and the Incidence of Rejection in Kidney Transplantation.

Abstract

Background: Kidney transplant (KT) recipients are at risk for developing neutropenia due to a wide range of post-transplant medications. There is controversy about the use of granulocyte colony stimulating factors (G-CSF) in SOTR as several small studies have suggested a link between use and rejection. The objective of this study is to identify the risk of acute cellular rejection in KT recipients who received ≥1 dose of G-CSF within the first year of transplant. Methods: Following IRB approval, a retrospective chart review was conducted on adult patients who underwent KT between 1/1/06 and 12/31/12. Only patients who received alemtuzumab and had documented biopsy results within the study period were included. Maintenance IS was protocol driven for all patients and generally included MMF and tacrolimus. The first episode of biopsy-proven rejection within 180 days of G-CSF administration or within 1 year post-transplant if no G-CSF was given were recorded. Rejection was classified by Banff 07 criteria. Results: 404 patients were included. 91 (22.5%) patients received ≥1 dose of G-CSF within the first year post-transplant. Demographics were similar between groups (Table 1). Rejection was more likely to occur (OR = 1.68, p=0.031) and be more severe (OR 2.26, p=0.007) in G-CSF patients than the control group (Table 2).Table: No Caption available.Table: No Caption available.Conclusion: The odds of rejection were higher in patients who received ≥1 dose of G-CSF within the first year of transplant. Patients were more likely to have moderate to severe rejection compared to mild or no rejection if they received G-CSF. An ongoing analysis is underway to identify other potential contributing factors for rejection.