Schneider J, Henningsen M, Pisarski P, Walz G, Jänigen B
Department of Medicine IV, Medical Center, Faculty of Medicine, University of Freiburg, Germany.
Department of General and Digestive Surgery, Section of Transplant Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Germany.
Int J Organ Transplant Med. 2021;12(2):1-8.
Leukopenia is a common problem after kidney transplantation. The therapeutic approach typically includes a reduction of the immunosuppressive therapy, which is associated with an increased risk of rejection and allograft loss. Granulocyte colony-stimulating factor (G-CSF) is used as a therapeutic option to raise the leukocyte blood count; however, the effect on acute rejections is controversial.
The goal of this study is to examine the incidence of acute rejections following G-CSF therapy.
We retrospectively evaluated patients with leukopenia following kidney transplantation and GCSF therapy between January 2007 and December 2017 at our center compared to controls with matched minimal leucocyte blood count in a matched pair analysis.
We identified 12 patients, who received G-CSF therapy with a cumulative dose of 10.74 µg/kg body weight over a time frame of 4.3 days. G-CSF therapy resulted in a significantly shorter time period with leucocytes <3,000/µL (9.5 vs. 16.6 days), but also trended towards an increased risk of rejection within the next 30 days with three patients in the G-CSF group and no patient in the control group (p=0.06) developing an acute biopsy-proven rejection. Infection and mortality rate in the subsequent year were not different between groups.
G-CSF therapy decreases the duration of leukopenia post-kidney transplantation, but may also increase the risk of an acute rejection.
白细胞减少是肾移植后常见的问题。治疗方法通常包括减少免疫抑制治疗，但这会增加排斥反应和移植肾丢失的风险。粒细胞集落刺激因子（G-CSF）被用作提高白细胞计数的一种治疗选择；然而，其对急性排斥反应的影响存在争议。
本研究的目的是检查G-CSF治疗后急性排斥反应的发生率。
我们回顾性评估了2007年1月至2017年12月在我们中心接受肾移植和G-CSF治疗的白细胞减少患者，并与配对分析中白细胞计数匹配的对照组进行比较。
我们确定了12例接受G-CSF治疗的患者，在4.3天的时间内累积剂量为10.74μg/kg体重。G-CSF治疗使白细胞<3000/μL的时间段显著缩短（9.5天对16.6天），但在接下来的30天内排斥反应风险也有增加的趋势，G-CSF组有3例患者发生急性活检证实的排斥反应，而对照组无患者发生（p=0.06）。随后一年中两组的感染率和死亡率无差异。
G-CSF治疗可缩短肾移植后白细胞减少的持续时间，但也可能增加急性排斥反应的风险。
