Use of granulocyte macrophage colony stimulating factor in children after orthotopic liver transplantation.
OBJECTIVE
Bacterial infections complicate the course of up to 80% of pediatric liver transplant recipients, and in some cases, neutropenia, surgical complications and/or antibiotic resistance prevent successful control of sepsis. The aim of the present study was to evaluate the safety and efficacy of granulocyte macrophage colony stimulating factors (GM-CSF) in treating neutropenia following pediatric orthotopic liver transplantation.


METHODS
Among a cohort of 430 pediatric orthotopic liver transplantation recipients, 13 children (12 months to 15 years, median 2 years, 10 males) received 15 courses of GM-CSF, 5 microg x kg(-1) x d(-1) subcutaneously, during their post-transplant course. In nine cases, the initial neutrophil count was below 1000/mm3. Ten patients were infected. Three received GM-CSF for severe sepsis without neutropenia. The mean duration of treatment was 16.3 days (range 4-49).


RESULTS
In all but one neutropenic patient the neutrophil count increased above 1500/mm3 and the mean neutrophil count increased from 1392+/-1912/mm3 (range 130-7170, median 640) to 4508+/-2459/mm3 (range 350-9630, median 4390) (p<0.01). Only one neutropenic patient (FK506 related) failed to respond to treatment. No rejection episode was induced by treatment, no side effects were noted, and patients with sepsis were cured.


CONCLUSIONS
In these patients, GM-CSF was safe, it achieved a significant increase in neutrophilic count, and was beneficial in patients with severe bacterial infections. This compound may prevent infectious complications in neutropenic patients and may benefit patients with severe sepsis with or without neutropenia.
Trindade
E
E
Cliniques St Luc, University of Louvain, Brussels, Belgium.
Maton
P
P
Reding
R
R
de Ville de Goyet
J
J
Otte
J B
JB
Buts
J P
JP
Sokal
E M
EM
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006084:Graft Rejection / Q000453:epidemiology; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007223:Infant; D007958:Leukocyte Count; D016031:Liver Transplantation / Q000401:mortality; D009503:Neutropenia / Q000097:blood / Q000139:chemically induced / Q000628:therapy*; D011183:Postoperative Complications; D018805:Sepsis / Q000628:therapy; D015996:Survival Rate; D016559:Tacrolimus / Q000009:adverse effects
D007166:Immunosuppressive Agents; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D016559:Tacrolimus