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논문분류	춘계학술대회 초록집
제목	Impact of Granulocyte Colony-Stimulating Factor on Graft and Patient Outcomes in Neutropenic Kidney Transplant Recipients
저자	Daeun Oh
출판정보	2026; 2026(1):
키워드	G-CSF, neutropenia , Kidney transplantation , acute rejection , graft failure
초록	Objectives: Neutropenia is a common complication after kidney transplantation and may be associated with increased susceptibility to infection and rejection. Management often requires reducing or discontinuing antimetabolites or antiviral agents, which may heighten alloimmune activity. Granulocyte colony-stimulating factor (G-CSF) is frequently used to correct post-transplant neutropenia, but evidence regarding its immunologic safety and its impact on graft and patient outcomes remains limited and inconsistent. This study evaluated whether G-CSF use in neutropenic kidney transplant recipients influences graft and patient outcomes. Methods: We performed a retrospective cohort study of adult kidney transplant recipients at Asan Medical Center from 2010 to 2023 who developed post-transplant neutropenia of CTCAE grade ≥2 (ANC <1500/μL). Patients were grouped by G-CSF exposure at the time of neutropenia. Primary outcomes included biopsy-proven acute rejection, graft survival, and patient survival. Results: Among 1,295 kidney transplant recipients who developed neutropenia, 366 (28%) received G-CSF. The cohort was 52% female, with a mean age of 46.5 years. Over a mean follow-up of 6.85 years, 71 deaths (5%), 303 biopsy-proven rejection events (23%), and 190 cases of graft failure requiring dialysis occurred. G-CSF use was associated with higher risks of rejection (HR 1.31, 95% CI 1.03–1.66), graft failure (HR 2.66, 95% CI 1.99–3.56), and death (HR 2.85, 95% CI 1.77–4.61) compared with no G-CSF use. Conclusion: G-CSF use in neutropenic kidney transplant recipients was associated with increased risks of rejection, graft failure, and mortality. These findings suggest that the decision to initiate G-CSF should be made cautiously and that closer monitoring may be warranted in this population.
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