Transpl Infect Dis. 2021 May 13:e13634. doi: 10.1111/tid.13634. Online ahead of print.
ABSTRACT
BACKGROUND: 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.
METHODS: 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 lab 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.
RESULTS: 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).
CONCLUSIONS: 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.
PMID:33982834 | DOI:10.1111/tid.13634
