Impact of Immunosuppressive Strategies on Post–Kidney Transplantation Thrombocytopenia

Gierczak, Valentine; Jouve, Thomas; Malvezzi, Paolo; Terrec, Florian; Naciri-Bennani, Hamza; Janbon, Bénédicte; Rostaing, Lionel; Noble, Johan

doi:10.1016/j.transproceed.2020.09.014

Cited by 3 publications

(6 citation statements)

References 31 publications

(40 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 3 In post-renal transplant state, immunosuppressants and other drugs (like mycophenolate, azathioprine, valganciclovir) and infections (CMV, EBV, parvovirus, dengue) may predispose to thrombocytopenia. 5 , 8 The treatment options for ITP include steroids immunosuppressive drugs (like azathioprine, mycophenolate, cyclosporine, rituximab), and other drugs like danazol, anti-D immunoglobulin, IVIg, with variable responses. 1 , 9 In case of life-threatening thrombocytopenia, pulse steroids and IVIg may be used.…”

Section: Discussionmentioning

confidence: 99%

Successful Renal Transplant in End-Stage Renal Disease with Chronic Immune Thrombocytopenia using Thrombopoietin Receptor Agonists and Intravenous Immunoglobulin

Behera,

K.P.,

Chauhan

et al. 2023

IJN

View full text Add to dashboard Cite

Chronic kidney disease in immune thrombocytopenia (ITP) is uncommon, and renal transplant in this setting is rare. We discuss the successful renal transplant of a 29-year-old male with chronic ITP. During transplant, he was managed with thrombopoietin receptor agonist eltrombopag, intravenous methylprednisone, and intravenous immunoglobulin to maintain adequate platelet level. He recovered well with no major complications and good graft function and has been stable during the follow-up period. The case report highlights that renal transplantation is a feasible option in patients with ITP, even in the presence of low platelet counts.

show abstract

Section: Discussionmentioning

confidence: 99%

Successful Renal Transplant in End-Stage Renal Disease with Chronic Immune Thrombocytopenia using Thrombopoietin Receptor Agonists and Intravenous Immunoglobulin

Behera,

K.P.,

Chauhan

et al. 2023

IJN

View full text Add to dashboard Cite

show abstract

“…ATG-F has already been implicated as a cause of early thrombocytopenia after kidney transplantation, particularly when associated with everolimus ( 10 – 13 , 28 , 29 ). Some studies reported that the lowest platelet count was reached on day 3 ( 12 , 30 ).…”

Section: Discussionmentioning

confidence: 99%

“…Some studies reported that the lowest platelet count was reached on day 3 ( 12 , 30 ). Clinically speaking, clinicians would rarely let platelet count decrease below 50 G/L without ordering frequent platelet transfusions ( 13 , 28 ); however, no such clinical outcomes have been reported ( 13 ). Our study confirmed early, not severe thrombocytopenia occurring within 7 days after kidney transplantation that did not need frequent platelet transfusion.…”

Section: Discussionmentioning

confidence: 99%

“…The specificity of ATG for T cell is not optimum, thus it is common to detect thrombocytopenia or anemia within days after injection ( 10 – 12 ). Thymo seems to induce more lymphopenia than ATG-F ( 9 ), whereas the latter causes significantly more post-transplantation thrombocytopenia ( 13 ). On the other hand, anemia and post-transplantation thrombocytopenia may necessitate blood product transfusion, a well-known factor of sensitization and development of anti-human leucocyte antigen (HLA) donor-specific antibodies (DSA) ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have compared the effectiveness of Thymo and ATG-F in kidney transplant recipients ( 9 , 10 , 16 , 17 ) and recorded the effects of each ATG type on the blood ( 10 – 13 ). However, the studied immunosuppressive therapy was not always the same; the clinical consequences, including red blood cell (RBC) transfusions, were not analyzed in all studies; and no data on DSA developed after transplantation, especially after RBC transfusion, were available.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

ATG-Fresenius increases the risk of red blood cell transfusion after kidney transplantation

et al. 2022

View full text Add to dashboard Cite

IntroductionIn sensitized deceased donor kidney allograft recipients, the most frequent induction therapy is anti-thymocyte globulins (ATG), including Thymoglobulin® (Thymo) and ATG-Fresenius (ATG-F).MethodsWe conducted a 3-year monocentric observational study to compare the impact of ATGs on hematological parameters. We included adult kidney transplant recipients treated with ATG induction therapy, either Thymo or ATG-F, on a one-in-two basis. The primary endpoint was red blood cell (RBC) transfusions within 14 days after transplantation.ResultsAmong 309 kidney allograft recipients, 177 (57.2%) received ATG induction, 90 (50.8 %) ATG-F, and 87 (49.2%) Thymo. The ATG-F group received significantly more RBC transfusions (63.3% vs. 46% p = 0.02) and in bigger volumes (p = 0.01). Platelet transfusion was similar in both groups. Within 14 and 30 days after transplantation, older age, ATG-F induction, and early surgical complication were independently associated with RBC transfusion. Patient survival rate was 95%, and the death-censored kidney allograft survival rate was 91.5% at 12 months post-transplantation. There was no difference in the incidence of acute rejection and infections or in the prevalence of anti-HLA donor-specific antibodies.DiscussionIn conclusion, after kidney transplantation, ATG-F is an independent risk factor for early RBC transfusion and early thrombocytopenia without clinical and biological consequences. These new data should be clinically considered, and alternatives to ATG should be further explored.

show abstract

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

Laxminarayana,

Jayaram,

Swaminathan

et al. 2024

F1000Res

View full text Add to dashboard Cite

Background Haematological abnormalities following renal transplantation are frequently observed and have a significant effect on survival and graft outcomes. The pattern of haematological abnormalities varies globally. Few studies have been conducted in Asian countries. We aimed to evaluate the patterns of haematological abnormalities in post-transplant recipients in our center during the first year after post-renal transplant and the association of post-transplant anemia with graft function. Methods This single-center retrospective study was conducted on renal transplantation recipients between 2014 and 2019. The study included all patients who received kidney transplants from live/cadaveric donors and had follow-up data collected up to 12 months after the transplant. The outcome studied was the prevalence of haematological abnormalities and the association between post-transplant anemia (PTA) and graft function in post-transplant recipients. Results A total of 106 renal transplant recipients were included in the study. The prevalence of PTA was 98% in the first week, 75% at one month, 35% at three months, 32% at six months, and 27% at 12 months. The other cytopenia cases were leukopenia (43.4%), thrombocytopenia (33.2%), and pancytopenia (15.1%). Post-transplant erythrocytosis was observed in 17.9% of patients. 18 patients with severe PTA in the first week of transplant had significant allograft dysfunction (p=0.04). Patients with and without PTA had similar graft functions at six and 12 months (p=0.50). Conclusions Haematological abnormalities are common in renal transplant recipients. PTA is highly prevalent during the first week and improves over time. Other haematological abnormalities observed were leukopenia, thrombocytopenia, pancytopenia, and post-transplant erythrocytosis. Leucopenia was primarily drug-induced, and thrombocytopenia and pancytopenia were frequently caused by infections in our cohort. Additionally, severe PTA was significantly associated with graft dysfunction in the first week post-transplant, whereas similar graft function was observed at 6 and 12 months post-transplant, irrespective of the presence or absence of PTA.

show abstract

Impact of Immunosuppressive Strategies on Post–Kidney Transplantation Thrombocytopenia

Cited by 3 publications

References 31 publications

Successful Renal Transplant in End-Stage Renal Disease with Chronic Immune Thrombocytopenia using Thrombopoietin Receptor Agonists and Intravenous Immunoglobulin

Successful Renal Transplant in End-Stage Renal Disease with Chronic Immune Thrombocytopenia using Thrombopoietin Receptor Agonists and Intravenous Immunoglobulin

ATG-Fresenius increases the risk of red blood cell transfusion after kidney transplantation

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

Contact Info

Product

Resources

About