title: Treatment and outcomes of immune cytopenias following solid organ transplant in children.
abstract: Immune cytopenias are a recognized life-threatening complication following pediatric solid organ transplants (SOT), but treatment responses and overall outcome are not well described. The aim of this study was to evaluate the demographic characteristics, response to treatments, and outcomes of a cohort of patients who developed immune cytopenias following SOT.
  
  
  
  In this single center retrospective review, patients with immune cytopenias after SOT were identified by electronic medical record (EMR) search and transplant databases from 1995-2012.
  
  
  
  Of 764 SOT patients, 19 (2.4%) developed immune cytopenias. Incidence varied widely by transplant type from 1.2% (renal) to 23.5% (multivisceral). Autoimmune hemolytic anemia (AIHA) was the most common immune cytopenia. Overall median time from transplant to immune cytopenia was 8 m and varied by transplant type from 3 m (liver) to 74 m (heart). Standard therapies for immune cytopenias were often used and ineffective. The most effective therapy for the immune cytopenia was changing immunosuppression from tacrolimus to another agent. Three of 19 patients died; none directly attributed to the immune cytopenia.
  
  
  
  Immune cytopenias are not rare after SOT, and patients usually do not respond well to traditional first line therapies. Provided that the risk of organ rejection is otherwise manageable, temporary cessation of tacrolimus could be more widely explored in this challenging clinical context. Pediatr Blood Cancer 2015;62:214-218. © 2014 Wiley Periodicals, Inc.
authors.affiliation: Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, Massachusetts.
authors.forename: Michelle
authors.initials: M
authors.lastname: Schoettler
authors.affiliation: Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Elisofon
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Heung Bae
authors.initials: HB
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Blume
authors.affiliation: Division of Nephrology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Nancy
authors.initials: N
authors.lastname: Rodig
authors.affiliation: Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Debra
authors.initials: D
authors.lastname: Boyer
authors.affiliation: Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, Massachusetts.
authors.forename: Ellis J
authors.initials: EJ
authors.lastname: Neufeld
authors.affiliation: Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, Massachusetts.
authors.forename: Rachael F
authors.initials: RF
authors.lastname: Grace
mesh_terms: D000744:Anemia, Hemolytic, Autoimmune / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007223:Infant; D008297:Male; D009503:Neutropenia / Q000188:drug therapy*; D016377:Organ Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use*; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab; D016559:Tacrolimus
keywords: autoimmune hemolytic anemia; autoimmune neutropenia; immune thrombocytopenia; solid organ transplant; tacrolimus