Characteristics and outcomes of neutropenia after orthotopic liver transplantation.

Autor: Alraddadi B; King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia., Nierenberg NE; Tufts Medical Center, School of Medicine, Tufts University, Boston, MA., Price LL; 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., Chow JK; Tufts Medical Center, School of Medicine, Tufts University, Boston, MA., Poutsiaka DD; Tufts Medical Center, School of Medicine, Tufts University, Boston, MA., Rohrer RJ; Tufts Medical Center, School of Medicine, Tufts University, Boston, MA., Cooper JT; Tufts Medical Center, School of Medicine, Tufts University, Boston, MA., Freeman RB; Dartmouth-Hitchcock Medical Center, Dartmouth College, New Lebanon, NH., Snydman DR; Tufts Medical Center, School of Medicine, Tufts University, Boston, MA.
Jazyk: angličtina
Zdroj: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2016 Feb; Vol. 22 (2), pp. 217-25.
DOI: 10.1002/lt.24332
Abstrakt: 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.
(© 2015 American Association for the Study of Liver Diseases.)
Databáze: MEDLINE
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