Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA.
Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Pharm Pract. 2024 Aug;37(4):830-837. doi: 10.1177/08971900231184308. Epub 2023 Jun 21.
BackgroundNeutropenia is a common complication in lung transplant recipients (LTRs). Filgrastim may be used to treat neutropenia in LTRs, but its consequences on acute cellular rejection (ACR) remain controversial. The purpose was to examine the association between filgrastim and incidence of ACR 6 months after filgrastim administration in LTRs. Secondary outcomes included burden of ACR, infections, chronic lung allograft dysfunction (CLAD), and survival. This was a matched cohort study of patients transplanted between January 2010 and October 2019. LTRs who received filgrastim for neutropenia were compared to a cohort who did not. LTRs were matched on transplant indication, sex, age, and time post-transplant and multivariable logistic regression models were used to evaluate the likelihood of ACR. 212 patients were included in the analysis (106 in each group). 50 patients (47.2%) in the filgrastim group experienced ACR compared to 37 patients (34.9%) in the no filgrastim group ( = .070). In multivariable analysis, filgrastim use was not associated with ACR at 6 months (OR 1.409, 95% CI 0.772-2.571). Time to first ACR was shorter ( = .049) and 6-month ACR score was higher in the filgrastim group (.49 vs .33, = .047). LTRs in the filgrastim group had higher incidence of bacterial pneumonia and 1-year mortality. Although not associated with increased likelihood of ACR at 6 months, our study found that filgrastim is associated with increased ACR burden and decreased time to ACR. This study can help inform clinicians of ACR risk after filgrastim use in LTRs.
中性粒细胞减少症是肺移植受者（LTR）的常见并发症。粒细胞集落刺激因子（Filgrastim）可用于治疗 LTR 的中性粒细胞减少症，但它对急性细胞排斥（ACR）的影响仍存在争议。本研究旨在探讨 LTR 接受 Filgrastim 治疗后 6 个月内 ACR 发生率与 Filgrastim 之间的关系。次要结局包括 ACR 负担、感染、慢性肺移植物功能障碍（CLAD）和生存率。这是一项回顾性匹配队列研究，纳入了 2010 年 1 月至 2019 年 10 月期间接受肺移植的患者。比较了因中性粒细胞减少症接受 Filgrastim 治疗的 LTR 与未接受 Filgrastim 治疗的患者。LTR 按照移植指征、性别、年龄和移植后时间进行匹配，采用多变量逻辑回归模型评估 ACR 的可能性。共纳入 212 例患者（每组 106 例）。Filgrastim 组 50 例（47.2%）患者发生 ACR，无 Filgrastim 组 37 例（34.9%）患者发生 ACR（ =.070）。多变量分析显示，Filgrastim 治疗与 6 个月时的 ACR 无关（OR 1.409，95%CI 0.772-2.571）。Filgrastim 组首次 ACR 时间较短（ =.049），6 个月时 ACR 评分较高（0.49 对 0.33， =.047）。Filgrastim 组 LTR 细菌性肺炎发生率和 1 年死亡率较高。尽管与 6 个月时 ACR 发生率增加无关，但本研究发现，Filgrastim 与 ACR 负担增加和 ACR 发生时间缩短有关。本研究可为临床医生提供 LTR 使用 Filgrastim 后 ACR 风险的信息。
