Frequency of Leukopenia Incidents following Azathioprine Therapy after
Kidney Transplantation

Oesterwitz, H; Horpácsy, G; May, G.; Mebel, M

doi:10.1159/000473941

Cited by 17 publications

(12 citation statements)

References 3 publications

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“…The complex etiology and treatment of anemia after renal transplantation have been discussed elsewhere . Leukopenia has also been reported with the use of several medications routinely used after transplantation, including antithymocyte globulin , azathioprine , sirolimus , (val)ganciclovir , trimethoprim‐sulfamethoxazole , and tacrolimus . Tacrolimus interacts with MMF by inhibiting MPA glucuronidation, increasing systemic MPA exposure, which contributes to the higher rate of leukopenia and diarrhea observed with the combination of tacrolimus and MMF than with that of cyclosporine and MMF .…”

Section: Discussionmentioning

confidence: 99%

Reasons for dose reduction of mycophenolate mofetil during the first year after renal transplantation and its impact on graft outcome

Vanhove

Claes²,

Evenepoel³

et al. 2013

Transpl Int

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Summary Mycophenolate mofetil (MMF) decreases the risk of acute rejection and is associated with improved graft survival in renal transplant recipients. However, MMF‐related side effects often necessitate dose reduction, which may expose patients to a higher risk of acute rejection and graft loss. This study's aim was to examine the reasons for MMF dose reduction during the first post‐transplant year and its impact on acute rejection, overall and death‐censored graft loss. Methods: Single‐center retrospective analysis of 749 renal transplant recipients treated with MMF in their initial maintenance immunosuppressive protocol. Results: In 365 patients (48.7%) a total of 530 MMF dose reductions were done. Reasons for reduction were hematologic toxicity (46.5%), infection (16.1%), gastrointestinal side effects (12.3%), malignancy (2.1%), study protocol (14.6%), and unknown (13.5%). MMF dose reduction as such was not an independent predictor of acute rejection or graft survival, although reductions in ≥50% of initial dose were significantly associated with acute rejection. Conclusions: In this retrospective cohort, by far the most important reason for MMF dose reduction during the first post‐transplantation year was hematologic. MMF dose reductions in ≥50% increased the risk of acute rejection but did not compromise graft survival.

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Section: Discussionmentioning

confidence: 99%

Reasons for dose reduction of mycophenolate mofetil during the first year after renal transplantation and its impact on graft outcome

Vanhove

Claes²,

Evenepoel³

et al. 2013

Transpl Int

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“…AZA causes leucopenia/neutropenia in around 50% of KTR [ 88 ]. Frequency of leucopenia increases significantly following azathioprine dosage exceeding 1.99 mg/kg body weight/day [ 89 ]. AZA induced leucopenia occurs earlier, usually during the first 5 weeks of transplantation.…”

Section: Insight Into Etiology Of Hematological Cytopenia and Subsmentioning

confidence: 99%

“…AZA induced leucopenia occurs earlier, usually during the first 5 weeks of transplantation. Most leucopenia settles after reducing the dose or temporary cessation of the drug [ 89 ]. Repeat leukopenic incident occurred in 70% of patients who previously had a drug leukopenic event [ 89 ].…”

Section: Insight Into Etiology Of Hematological Cytopenia and Subsmentioning

confidence: 99%

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

Khalil

Khan

et al. 2018

Journal of Transplantation

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Drug-induced hematological cytopenia is common in kidney transplantation. Various cytopenia including leucopenia (neutropenia), thrombocytopenia, and anemia can occur in kidney transplant recipients. Persistent severe leucopenia or neutropenia can lead to opportunistic infections of various etiologies. On the contrary, reducing or stopping immunosuppressive medications in these events can provoke a rejection. Transplant clinicians are often faced with the delicate dilemma of balancing cytopenia and rejection from adjustments of immunosuppressive regimen. Differentials of drug-induced cytopenia are wide. Identification of culprit medication and subsequent modification is also challenging. In this review, we will discuss individual drug implicated in causing cytopenia and correlate it with corresponding literature evidence.

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“…There are no current practice guidelines for management of PTN in kidney transplant recipients, and PTN or leukopenia has been reported with many transplant medications to include anti-lymphocyte globulin (4), thymoglobulin (5,6), azothioprine (4,(7)(8)(9), mycophenolate (10), sirolimus (11), valacyclovir (12), valgancyclovir (13), and trimethoprimsulfamethoxazole (14). Generally, the above medications are not given individually, and cytopenias have been reported from various combinations (12,14) of medications, possibly related to idiosyncratic drug-drug interactions.…”

mentioning

confidence: 99%

Poor Outcomes Associated With Neutropenia After Kidney Transplantation: Analysis of United States Renal Data System

et al. 2011

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Frequency of Leukopenia Incidents following Azathioprine Therapy after Kidney Transplantation

Cited by 17 publications

References 3 publications

Reasons for dose reduction of mycophenolate mofetil during the first year after renal transplantation and its impact on graft outcome

Reasons for dose reduction of mycophenolate mofetil during the first year after renal transplantation and its impact on graft outcome

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

Poor Outcomes Associated With Neutropenia After Kidney Transplantation: Analysis of United States Renal Data System

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