Use of granulocyte macrophage colony stimulating factor in children after orthotopic liver transplantation

Background/Aims: Bacterial infections complicate the course of up to 80% of pediatric liver transplant recipients, and in some cases, neutropenia, surgical complications and/or antibiotic resistance prevent successful control of sepsis. The aim of the present study was to evaluate the safety and efficacy of granulocyte macrophage colony stimulating factors (GM-CSF) in treating neutropenia following pediatric orthotopic liver transplantation. Methods: Among a cohort of 430 pediatric orthotopic liver transplantation recipients, 13 children (12 months to 15 years, median 2 years, 10 males) received 15 courses of GM-CSF, 5 μg · kg^-1 · d^-1 subcutaneously, during their post-transplant course. In nine cases, the initial neutrophil count was below 1000/ram³. Ten patients were infected. Three received GM- CSF for severe sepsis without neutropenia. The mean duration of treatment was 16.3 days (range 449). Results: In all but one neutropenic patient the neutrophil count increased above 1500/mm³ and the mean neutrophil count increased from 1392±1912/mm³ (range 130-7170, median 640) to 4508±2459/mm³ (range 350-9630, median 4390) (p