P15.03: Granulocyte Colony-Stimulating Factor With or Without Immunosuppression Reduction in Neutropenic Kidney Transplant Recipients
Bibliographic record
Abstract
Introduction: Neutropenia, defined as an absolute neutrophil count (ANC) of < 1,500/mm3, is a common complication after kidney transplantation (KT). It is associated with adverse graft and patient outcomes, yet little is known about the best management practices for neutropenia in transplant recipients. We aimed to analyze the effect of granulocyte colony-stimulating factor (G-CSF) use with and without immunosuppression reduction on graft outcomes in neutropenic KT recipients. Methods: We conducted a retrospective cohort study of adult (age ≥18), deceased donor recipients of KT between September 1, 2011, and December 31, 2016, who developed neutropenia within the first-year post-KT. We excluded multiorgan transplant recipients, those who were undergoing re-KT, those with a history of HIV, or primary nonfunction. Clinically significant neutropenia was defined as 1) Two consecutive ANC of < 1500/mm3; or 2) One ANC value < 1500 cells/mm3 associated with a decrease in maintenance immunosuppression within 30 days of detection of neutropenia. Severe neutropenia was defined as an ANC < 500/mm3. Results: We identified 120 recipients with neutropenia, within the first-year post-transplant. Of these, 45.0% underwent no intervention, 17.5% had immunosuppression reduced, 18.3% were only given G-CSF, and 19.2% had both interventions. Overall, 61 patients experienced the composite outcome of de-novo DSA, biopsy-proven acute rejection, and all-cause graft failure and the cumulative incidence of this outcome did not vary by any of the four interventions (p=0.93) (Figure). When stratifying the cohort by G-CSF use alone, those who received G-CSF were more likely to have had moderate (46.7% vs. 42.7%) or severe neutropenia (51.1% vs. 12.0%, p<0.001), and were more likely to have had immunosuppression reduction (51.1% vs. 28.0%, p=0.003). However, the composite outcome was not different in the G-CSF and no G-CSF cohort (53.3% vs. 49.3%, p=0.67), and in a multivariate model, G-CSF use was not associated with this outcome (aHR=1.18, 95%CI:0.61-2.30).Conclusion: We conclude that G-CSF use with or without immunosuppression reduction was not associated with graft outcomes; however, this observation warrants prospective evaluation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".