title: Granulocyte colony-stimulating factor therapy is associated with a reduced incidence of acute rejection episodes or allograft vasculopathy in heart transplant recipients.
abstract: BACKGROUND
  We evaluated the potential effects of granulocyte colony-simulating factor (G- CSF) on the incidence of rejection and allograft vasculopathy in heart transplant recipients.
  
  
  METHODS
  Of 247 patients undergoing heart transplantation from 2000 to 2007, 52 (21%) developed leukopenia (white blood cell [WBC] <2.5 × 10(9) cells/L) in the absence of active infection, rejection, or malignancy. In 24 (46%) patients a clinical decision was made to treat the leukopenia with G-CSF (G-CSF group), and 28 (54%) Patients received no G-CSF (non-GCSF group). Patients followed up for 1 year after the period of leukopenia were assessed for allograft vasculopathy and acute rejection incidence.
  
  
  RESULTS
  At baseline, the G-CSF group and the non-GCSF group did not differ in age, gender, race, heart failure etiology, creatinine, left ventricular ejection fraction (LVEF) or immunosupressive regimen. During 1-year follow-up there were no deaths in the G-CSF group, and 1 death in the non-GCSF group (P = .34). The incidence of rejection or progressive allograft vasculopathy was lower in the G-CSF group when compared with the non-GCSF group (2 [8%] vs 15 [53%]; P < .01). Multivariate analysis identified both prior rejection episodes and G-CSF therapy as factors associated with the combined end-point of rejection or progressive allograft vasculopathy (odds ratio [OR] = 7.89 [1.67-37.2] and OR = 0.09 [0.02-0.52], respectively).
  
  
  CONCLUSIONS
  G-CSF therapy appears to be associated with a decreased incidence of acute rejection episodes or allograft vasculopathy in heart transplant recipients, suggesting a potential immunomodulatory effect of G-CSF.
authors: Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA. bvrtovec@stanford.edu
authors: B
authors: B
authors: Vrtovec
authors: F
authors: F
authors: Haddad
authors: M
authors: M
authors: Pham
authors: T
authors: T
authors: Deuse
authors: W F
authors: WF
authors: Fearon
authors: S
authors: S
authors: Schrepfer
authors: S
authors: S
authors: Leon
authors: T
authors: T
authors: Vu
authors: H
authors: H
authors: Valantine
authors: S A
authors: SA
authors: Hunt
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D064591:Allografts; D002140:California / Q000453:epidemiology; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control*; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D015994:Incidence; D007958:Leukocyte Count; D007970:Leukopenia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007155:Immunologic Factors; D016179:Granulocyte Colony-Stimulating Factor