Risk Factors and Outcomes of Neutropenia Following Pediatric Liver Transplant

Solid-organ transplant is an ideal treatment option for patients with end-organ dysfunction, and post-transplant neutropenia in recipients causes higher rates of infection, rejection, and mortality. We aimed to determine the incidence rates, risk factors, and clinical outcomes of neutropenia during the first year after pediatric liver transplant.

We conducted a retrospective evaluation of data from 60 pediatric liver recipients who had developed post-transplant neutropenia within the first year at the Baskent University Ankara Hospital Solid Organ Transplantation Center. Patient data were collected from computer records from September 2013 to September 2023.

Mean age of liver recipients (58.3% male) who developed posttransplant neutropenia was 4.82 ± 4.93 years (minimum-maximum, 4.5 months to 17.5 years). Immunity to cytomegalovirus pretransplant was shown by 75% of recipients and 94.5% of donors. During the neutropenia period, 40% of recipients were diagnosed with sepsis as etiology of neutropenia. Other etiologies were 28.33% immunosuppressive drug use, 11.6% cholangitis, 8.3% bacterial pneumonia, and 6.6% cytomegalovirus disease. After the neutropenia period, complications developed: invasive fungal infection in 13.3% of the patients and sepsis in 20%. However, 81.3% of patients recovered completely from neutropenia. Within the first year, acute graft rejection developed in 16.9% of patients and chronic graft rejection in 6.7% of patients; mortality rate due to all causes, including infection, was 11.8%. Hospitalization events were significantly higher in the neutropenic roup than in the control group within the first posttransplant year (P = .003). Mortality rates were higher in the neutropenia group (11.86%) versus the control group (5%), but this difference was not significant (P > .05).

This study identified thatinfection, as well as the use of immunosuppressive drugs inherent to the liver transplant process, was the most important etiological factors in the development of posttransplant neutropenia.