Cytopenia occurrence in kidney transplant recipients within early post-transplant period

Abstract

Objective:This study assessed incidence, severity, and time to occurrence of drug-induced leukopenia/thrombocytopenia within 1st month 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 1st month after transplantation were collected.Findings: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.Conclusion: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.

Drug-Induced Hematological Cytopenia in Kidney Transplantation and the Challenges It Poses for Kidney Transplant Physicians

“…A delicate balance is needed to prevent rejection and avoid various complications including cytopenia. Cytopenia is common in kidney transplant recipients [ 1 ]. Twenty to sixty % of KTR will have one episode of either neutropenia or cytopenia during the course of their transplant [ 2 ].…”

Pitfalls in Valganciclovir Prophylaxis Dose Adjustment Based on Renal Function in Kidney Transplant Recipients

“…Cytopenia is part of the numerous complications occurring post-transplantation and is known to complicate treatment administration in up to 60% of KTR who will experience at least one episode of leucopenia or neutropenia [ 25 ]. A meta-analysis found that VGC 900 mg daily was associated with a 3.3 times greater risk of leucopenia [ 26 ].…”

Post kidney transplant hematologic abnormalities and association of post-transplant anemia with graft function

“…The estimated incidence of leukopenia in kidney transplant patients ranges from 10-55%. 9 There is also a high rate of thrombocytopenia following renal transplantation in the first year, with the majority of recipients experiencing the lowest platelet counts within the first three months after the transplant 10 which causes an oxygen deficit and immune system dysfunction that have a broad impact on the body. 11 Post-transplant erythrocytosis is usually observed in 10-15% of patients 12 and is typically evident within the first year of transplant.…”