Characteristics and outcomes of neutropenia after orthotopic liver transplantation.
Neutropenia after orthotopic liver transplantation (LT) is relatively common, but the factors associated with its development remain elusive. We assessed possible predictors of neutropenia (absolute neutrophil count [ANC] ≤ 1000/mm(3) ) within the first year of LT in a cohort of 304 patients at a tertiary medical center between 1999 and 2009 using time-dependent survival analysis to identify risk factors for neutropenia. In addition, we analyzed neutropenia as a predictor of the clinical outcomes of death, bloodstream infection (BSI), invasive fungal infection, cytomegalovirus (CMV) disease, and graft rejection within the first year of LT. Of the 304 LT recipients, 73 (24%) developed neutropenia, 5 (7%) of whom had grade 4 neutropenia (ANC < 500/mm(3) ). The following were independent predictors for neutropenia: Child-Turcotte-Pugh score (hazard ratio [HR] 1.15; 95% confidence interval [CI], 1.03-1.30; P = 0.02), BSI (HR, 2.89; 95% CI, 1.63-5.11; P < 0.001), CMV disease (HR, 4.28; 95% CI, 1.55-11.81; P = 0.005), baseline tacrolimus trough level (HR, 1.02; 95% CI, 1.01-1.03; P = 0.007), and later era LT (2004-2009 versus 1999-2003; HR, 2.28; 95% CI, 1.43-3.65; P < 0.001). Moreover, neutropenia was found to be an independent predictor for mortality within the first year of LT (HR, 3.76; 95% CI, 1.84-7.68; P < 0.001). In conclusion, our data suggest that neutropenia within a year after LT is not unusual and is an important predictor of mortality.
King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
Basem
B
Alraddadi
Tufts Medical Center, School of Medicine, Tufts University, Boston, MA.
Natalie E
NE
Nierenberg
The Institute for Clinical Research and Health Policy Studies, Tufts University, Boston, MA.|Tufts Medical Center, School of Medicine, Tufts University, Boston, MA.|Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.
Lori Lyn
LL
Price
Tufts Medical Center, School of Medicine, Tufts University, Boston, MA.
Jennifer K L
JK
Chow
Tufts Medical Center, School of Medicine, Tufts University, Boston, MA.
Debra D
DD
Poutsiaka
Tufts Medical Center, School of Medicine, Tufts University, Boston, MA.
Richard J
RJ
Rohrer
Tufts Medical Center, School of Medicine, Tufts University, Boston, MA.
Jeffrey T
JT
Cooper
Dartmouth-Hitchcock Medical Center, Dartmouth College, New Lebanon, NH.
Richard B
RB
Freeman
Tufts Medical Center, School of Medicine, Tufts University, Boston, MA.
David R
DR
Snydman
D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000150:complications; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications; D009503:Neutropenia / Q000209:etiology* / Q000628:therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D007166:Immunosuppressive Agents