USE OF GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR IN CHILDREN AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

Background/Aims: Bacterial infections complicate the course of up to 8 0% of pediatric liver transplant recipients, and in some cases, neutro penia, surgical complications and/or antibiotic resistance prevent suc cessful control of sepsis. The aim of the present study was to evaluat e the safety and efficacy of granulocyte macrophage colony stimulating factors (GM-CSF) in treating neutropenia following pediatric orthotop ic liver transplantation. Methods: Among a cohort of 430 pediatric ort hotopic liver transplantation recipients, 13 children (12 months to 15 years, median 2 years, 10 males) received 15 courses of GM-CSF, 5 mu g . kg(-1) . d(-1) subcutaneously, during their post-transplant course . In nine cases, the initial neutrophil count was below 1000/mm(3). Te n patients were infected. Three received GM-CSF for severe sepsis with out neutropenia. The mean duration of treatment was 16.3 days (range 4 -49). Results: In all but one neutropenic patient the neutrophil count increased above 1500/mm(3) and the mean neutrophil count increased fr om 1392+/-1912/mm(3) (range 130-7170, median 640) to 4508+/-2459/mm(3) (range 350-9630, median 4390) (p<0.01). Only one neutropenic patient (FK506 related) failed to respond to treatment. No rejection episode w as induced by treatment, no side effects were noted, and patients with sepsis were cured. Conclusion: In these patients, GM-CSF was safe, it achieved a significant increase in neutrophilic count, and,vas benefi cial in patients with severe bacterial infections. This compound may p revent infectious complications in neutropenic patients and may benefi t patients with severe sepsis with or without neutropenia.