Increase in short-term risk of rejection in heart transplant patients receiving granulocyte colony-stimulating factor

J Heart Lung Transplant. 2018 Nov;37(11):1322-1328. doi: 10.1016/j.healun.2018.06.009. Epub 2018 Jun 30.


Background: Neutropenia is a significant adverse event after heart transplantation (HT) and increases infection risk. Granulocyte colony-stimulating factor (G-CSF) is commonly used in patients with neutropenia. In this work, we assessed the adverse effects of G-CSF treatment in the setting of a university hospital.

Methods: Data on HT patients from January 2008 to July 2016 were reviewed. Patients who received G-CSF were identified and compared with patients without a history of therapy. Baseline characteristics, rejection episodes, and outcomes were collected. Data were analyzed by incidence rates, time to rejection and survival were analyzed using Kaplan-Meier curves, and odds ratios were generated using logistic regression analysis.

Results: Two hundred twenty-two HT patients were studied and 40 (18%) received G-CSF for a total of 85 total neutropenic events (0.79 event/patient year). There were no differences in baseline characteristics between the groups. In the 3 months after G-CSF, the incidence rate of rejection was 0.067 event/month. In all other time periods considered free of G-CSF effect, the incidence rate was 0.011 event/month. This rate was similar to the overall incidence rate in the non-GCSF group, which was 0.010 event/month. There was a significant difference between the incidence rates in the G-CSF group at 0 to 3 months after G-CSF administration and the non-GCSF group (p = 0.04), but not for the other time periods (p = 0.5). Freedom from rejection in the 3 months after G-CSF administration was 87.5% compared with 97.5% in the non-GCSF group (p = 0.006).

Conclusions: G-CSF administration was found to be associated with significant short-term risk of rejection. This suggests the need for increased surveillance during this time period.

Keywords: G-CSF; acute rejection; heart transplantation; immunosuppression; infection prophylaxis; neutropenia.

MeSH terms

  • Female
  • Graft Rejection / chemically induced*
  • Granulocyte Colony-Stimulating Factor / adverse effects*
  • Granulocyte Colony-Stimulating Factor / therapeutic use
  • Heart Transplantation*
  • Hospitals, University
  • Humans
  • Male
  • Middle Aged
  • Neutropenia / drug therapy
  • Risk


  • Granulocyte Colony-Stimulating Factor