Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA.
Tufts Clinical and Translational Science Institute, Biostatistics, Epidemiology, and Research Design Center, Tufts Medical Center, Boston, MA, USA.
Transpl Infect Dis. 2021 Aug;23(4):e13634. doi: 10.1111/tid.13634. Epub 2021 Jun 1.
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.
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 laboratory measurements were collected within the 24 hours before OHT. Neutropenia was defined as absolute neutrophil count ≤1000 cells/mm3. Cox proportional hazards models explored associations with time to first neutropenia. Associations between neutropenia, analyzed as a time-dependent covariate, with secondary outcomes of time to infection, rejection, or death were also examined.
Of 278 OHT recipients, 84 (30%) developed neutropenia at a median of 142 days (range 81-228) after transplant. Factors independently associated with increased risk of neutropenia included lower baseline WBC (HR 1.12; 95% CI 1.11-1.24), pre-OHT ventricular assist device (1.63; 1.00-2.66), high-risk CMV serostatus [donor positive, recipient negative] (1.86; 1.19-2.88), and having a previous CMV infection (4.07; 3.92-13.7).
Neutropenia is a fairly common occurrence after adult OHT. CMV infection was associated with subsequent neutropenia, however, no statistically significant differences in outcomes were found between neutropenic and non-neutropenic patients in this small study. It remains to be determined in future studies if medication changes in response to neutropenia would impact patient outcomes.
中性粒细胞减少症是心脏移植（OHT）后的一种严重并发症；然而，其发展的危险因素及其与结局的关系尚不清楚。我们旨在研究中性粒细胞减少症的患病率、与其发生相关的危险因素，以及其对感染、排斥和存活的影响。
对 2004 年 7 月至 2017 年 12 月期间进行的成人 OHT 受者进行了回顾性单中心分析。收集了 OHT 后 1 年的人口统计学、实验室、药物、感染、排斥和存活数据。基线实验室测量值在 OHT 前 24 小时内收集。中性粒细胞减少症定义为绝对中性粒细胞计数≤1000 个细胞/mm3。Cox 比例风险模型探讨了与首次中性粒细胞减少症发生时间的关联。还分析了中性粒细胞减少症作为时间依赖性协变量与感染、排斥或死亡的次要结局之间的关系。
在 278 例 OHT 受者中，84 例（30%）在移植后中位数 142 天（范围 81-228）时发生中性粒细胞减少症。与中性粒细胞减少症风险增加相关的因素包括基线白细胞计数较低（HR 1.12；95%CI 1.11-1.24）、OHT 前心室辅助装置（1.63；1.00-2.66）、高风险 CMV 血清状态[供体阳性、受体阴性]（1.86；1.19-2.88）和有 CMV 既往感染史（4.07；3.92-13.7）。
中性粒细胞减少症是成人 OHT 后相当常见的事件。CMV 感染与随后的中性粒细胞减少症相关，但在这项小型研究中，中性粒细胞减少症患者和非中性粒细胞减少症患者的结局之间没有统计学上的显著差异。在未来的研究中，中性粒细胞减少症患者是否需要改变药物治疗以改善患者结局仍有待确定。
