Characteristics, risk factors, and outcomes of neutropenia after liver or kidney transplantation in children

Abstract

Background: While prior adult studies have shown that approximately 20%-38% of subjects undergoing solid-organ transplant develop neutropenia, similar analyses in pediatric subjects are scarce. Methods:We conducted a retrospective chart review of liver transplant (LT) and kidney transplant (KT) recipients at our center during the period 2008-2018. All of the KT and none of the LT subjects during this time period had induction with either anti-thymocyte globulin (ATG) or basiliximab at time of transplant. Neutropenia was defined as absolute neutrophil count (ANC) value ≤1000/mm 3 .Results: One hundred subjects with LT and 82 subjects with KT were included. The incidence of neutropenia within the first year of transplant in KT was higher compared to LT (54.8% vs 39%, p = .01). The median number of hospitalizations (p = .001) and infectious complications (p = .04) was significantly higher only in the KT subjects who developed neutropenia (compared to those who did not). Multivariate analysis identified factors associated with severity of liver disease at transplant, namely h/o upper gastrointestinal bleeding (p = .02), weight deficit (p = .01), and pre-LT ANC (p = .01), along with high or moderate risk cytomegalovirus status (p = .05) as predictors of neutropenia in LT subjects. Female gender (p = .03) predicted neutropenia, while BK virus infection was protective for neutropenia (p = .04) in KT subjects. Conclusions:The incidence of and morbidity associated with neutropenia within 1 year post-transplant is higher in KT subjects compared to LT subjects. The likely reason for this is the use of induction therapy (ATG, basiliximab) at the time of transplant in KT subjects.

Cytopenias in Pediatric Kidney Transplant Recipients: Risk Factors and Clinical Consequences

“…Previous studies in adults demonstrate a rate of 6-8% severe PTNs [10,16,22]. These nding are consistent with the suggestion of Jarasvaraparn et al, that children have a higher incidence and a higher rate of severe episodes of PTN when compared to adults [21]. Possible explanations for the increased incidence and severity of neutropenia in pediatric KTRs include higher serum concentrations of medications known to cause bone marrow suppression without available tests for drug levels, increased sensitivity of the bone marrow to suppressive effects of medications and/or infections, and a higher incidence of viral infections in pediatric solid-organ transplant recipients.…”

“…The prevalence of any PTN was 60% (53 patients out of 89 KTRs) which is consistent with Becker-Cohen's ndings, which demonstrated a 64% prevalence of pediatric PTN in a mean follow up time of 4.4 years [27]. Another study on pediatric KTRs demonstrated a prevalence of 54.8% of PTN during the rst follow up year, using a stricter threshold for de ning neutropenia as ANC ≤ 1000 [21]. Both studies included similar cohort sizes relative to our study.…”

“…Although several studies have aimed to focus on drugs and clinical conditions leading to cytopenias following kidney transplantation [9,11,[15][16][17][18][19][20][21][22], many questions remain unanswered. This study aimed to evaluate the incidence, characteristics, and risk factors for cytopenias, and their consequences, in the pediatric kidney-transplant population.…”

Granulocyte colony‐stimulating factor with or without immunosuppression reduction in neutropenic kidney transplant recipients

“…A systematic review of cancer patients has demonstrated that primary support with C‐CSF is associated with 7% lower all‐cause mortality 20 . In the field of KT several idiosyncratic medication interactions and CMV infection can cause neutropenia and clinicians experience complex management dilemmas 1,3–11 . The most common strategy to treat neutropenia is to reduce maintenance immunosuppression, however, G‐CSF use is increasingly reported.…”

Neutropenia in pediatric solid organ transplant

“…[7][8][9][10] CMV does not typically cause neutropenia in immunocompetent individuals but is a component of the CMV syndrome that includes fever, malaise, atypical lymphocytosis, leukopenia, thrombocytopenia, and/or elevated hepatic transaminases as well as symptomatic end-organ disease. 14,50 High-risk CMV serostatus has been associated with risk of neutropenia in a cohort of 100 pediatric kidney and liver transplant recipients 56 as well as large cohorts of adult liver, kidney, and heart recipients, 30,57,58 although it can be difficult to separate the effects of CMV serostatus from those of prophylactic valganciclovir.…”