title: Management of leukopenia in kidney and pancreas transplant recipients.
abstract: Leukopenia is frequently observed in the setting of solid organ transplantation. The risk factors, natural history, and outcomes associated with leukopenia post-transplantation have not been well defined. We retrospectively studied 102 adult kidney and/or pancreas transplant recipients over a one-yr period of time. By defining leukopenia as a white blood cell count < or =3000 cells/mm(3) and neutropenia as an absolute neutrophil count < or =2000/mm(3), the combined incidence of either leukopenia or neutropenia was 58% (59/102); the first episode occurred at a mean of 91 d post-transplant. A significant increase in the incidence of leukopenia was found in patients who either received alemtuzumab induction (42% with alemtuzumab vs. 9% with rabbit anti-thymocyte globulin induction, p < 0.05) and/or had rapid steroid withdrawal in the early post-transplant period (44% with vs. 16% without steroid withdrawal, p < 0.05). The most common intervention performed for leukopenia was reducing the dose of mycophenolate mofetil and/or valganciclovir. When granulocyte stimulating factors were used, a mean of 3.1 doses were needed to successfully manage the leukopenia. Although leukopenia was a common finding in our study of kidney and/or pancreas transplant recipients, there was no difference in the rates of infection or acute rejection in patients with and without leukopenia.
authors.affiliation: Department of Nephrology, Wake Forest University, Winston-Salem, NC 27157-1053, USA. ehartman@wfubmc.edu
authors.forename: Erica L
authors.initials: EL
authors.lastname: Hartmann
authors.forename: Mandy
authors.initials: M
authors.lastname: Gatesman
authors.forename: Julie
authors.initials: J
authors.lastname: Roskopf-Somerville
authors.forename: Robert
authors.initials: R
authors.lastname: Stratta
authors.forename: Alan
authors.initials: A
authors.lastname: Farney
authors.forename: Aimee
authors.initials: A
authors.lastname: Sundberg
mesh_terms: D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006084:Graft Rejection / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D007970:Leukopenia / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016035:Pancreas Transplantation; D011183:Postoperative Complications / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D000077562:Valganciclovir
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000961:Antilymphocyte Serum; D000970:Antineoplastic Agents; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D016179:Granulocyte Colony-Stimulating Factor; D000074323:Alemtuzumab; D000077562:Valganciclovir; D009173:Mycophenolic Acid; D015774:Ganciclovir