Rose-Felker Kirsten, Mukhtar Ayesha, Kelleman Michael S, Deshpande Shriprasad R, Mahle William T
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, GA, USA.
Pediatr Transplant. 2018 May;22(3):e13130. doi: 10.1111/petr.13130. Epub 2018 Feb 23.
Neutropenia has been reported in pediatric heart transplant recipients, but its association with infectious morbidity and mortality is unknown. We sought to determine neutropenia's prevalence and impact on infection, rejection, and survival. A retrospective analysis of pediatric heart transplant recipients from March 2005 to August 2015 was performed. Demographics, medications, infection, and rejection data were collected. Of 142 pediatric heart transplant recipients, 77 (54.2%) developed neutropenia within 4.7 months [3.3-12.1 months] of transplant. In all patients, the adjusted 5-year cumulative incidence of neutropenia was 30.2%. Fifty-one patients (66.2%) had recurrent neutropenia. Six of 14 tested had positive antineutrophil antibodies. Medications associated with neutropenia were decreased in 15 (19.5%) and discontinued in 42 (54.4%) patients with no change in 1-year rejection rates compared to published data. Fifteen patients developed infection within 30 days of neutropenia and two from 30 days to 1 year, with an infection rate similar to the non-neutropenic group. There was no significant difference in survival, ANC, rate of rejection or PTLD in neutropenic patients with and without infection at median follow-up (5.5 years). Neutropenia is common in pediatric heart transplant recipients. Neutropenia had <20% risk of associated infection, similar to non-neutropenic patients. Infection in neutropenic patients did not increase mortality.
小儿心脏移植受者中曾有中性粒细胞减少症的报道，但其与感染性发病率及死亡率之间的关联尚不清楚。我们试图确定中性粒细胞减少症的患病率及其对感染、排斥反应和生存率的影响。对2005年3月至2015年8月期间的小儿心脏移植受者进行了回顾性分析。收集了人口统计学、用药情况、感染及排斥反应数据。在142例小儿心脏移植受者中，77例（54.2%）在移植后4.7个月[3.3 - 12.1个月]内出现中性粒细胞减少症。所有患者中，中性粒细胞减少症的校正5年累积发病率为30.2%。51例患者（66.2%）出现复发性中性粒细胞减少症。14例接受检测的患者中有6例抗中性粒细胞抗体呈阳性。与中性粒细胞减少症相关的药物在15例（19.5%）患者中减量，42例（54.4%）患者停药，与已发表数据相比，1年排斥反应率无变化。15例患者在中性粒细胞减少症发生后30天内发生感染，2例在30天至1年内发生感染，感染率与非中性粒细胞减少症组相似。在中位随访期（5.5年）时，有感染和无感染的中性粒细胞减少症患者在生存率、中性粒细胞绝对计数、排斥反应率或移植后淋巴增殖性疾病方面无显著差异。中性粒细胞减少症在小儿心脏移植受者中很常见。中性粒细胞减少症患者发生相关感染的风险<20%，与非中性粒细胞减少症患者相似。中性粒细胞减少症患者发生感染并未增加死亡率。
