Cytopenia Occurrence in Kidney Transplant Recipients Within Early Post-transplant Period.
OBJECTIVE
This study assessed incidence, severity, and time to occurrence of drug-induced leukopenia/thrombocytopenia within 1stmonth after kidney transplantation.


METHODS
This cross-sectional study was conducted on newly kidney transplant recipients from two hospitals, Iran. Patients with thrombocytopenia due to acute antibody-mediated rejection were excluded from the study. Demographic, clinical, and laboratory data of patients within the 1stmonth after transplantation were collected.


RESULTS
Of 213 patients, 14.1% and 66.2% experienced leukopenia and thrombocytopenia, respectively. Cytopenia happened more commonly among patients with thymoglobulin-containing regimen (for leukopenia: 24.6% vs. 0%,P< 0.001; for thrombocytopenia 84.4% vs. 41.8%,P< 0.001). Most leukopenia patients experienced Grades 1 and 2 of leukopenia (46.6% and 40% of patients). Most thrombocytopenic patients showed Grade 1 of thrombocytopenia (78.7%). Cumulative dose of thymoglobulin did not differ between patients with and without leukopenia (5.57 ± 1.13 vs. 5.9 ± 1.96 mg/kg;P= 0.613) or with and without thrombocytopenia (5.87 ± 1.86 vs. 5.56 ± 1.38 mg/kg;P= 0.29). Cytopenia were more common among recipients from deceased compared with from living donors (91.3% vs. 8.7% for leukopenia patients,P= 0.001; 69.9% vs. 33.1% for thrombocytopenia,P= 0.02). More patients with kidney from deceased donors received thymoglobulin in their immunosuppressive regimen (82% vs. 37%;P< 0.001). The median time to leukopenia and thrombocytopenia were 3 days and 1 day, respectively.


CONCLUSIONS
Among immunosuppressive and prophylactic antimicrobial agents, thymoglobulin is more related to cytopenia; therefore, thymoglobulin dose reduction is recommended as the first intervention to manage cytopenia without need for reduction of its cumulative dose. The higher prevalence of cytopenia among recipients from deceased donors may be related to the higher use of thymoglobulin in these patients.
Department of Clinical Pharmacy, Guilan University of Medical Sciences, Rasht, Iran.
Atefeh
A
Jafari
Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Parisa
P
Najivash
Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran; Center of Excellence in Nephrology, Tehran University of Medical Sciences, Tehran, Iran.
Mohammad-Reza
MR
Khatami
Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran; Center of Excellence in Nephrology, Tehran University of Medical Sciences, Tehran, Iran.
Simin
S
Dashti-Khavidaki
Kidney transplantation; leukopenia; thrombocytopenia; thymoglobulin