Incidence and Management of Leukopenia/Neutropenia in 233 Kidney Transplant Patients Following Single Dose Alemtuzumab Induction

Smith, Alison; Couvillion, R.; Zhang, R.; Killackey, Mary; Buell, Joseph F.; Lee, B.; Saggi, Bob H.; Paramesh, Anil

doi:10.1016/j.transproceed.2014.07.070

Cited by 24 publications

(35 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although neutropenia has been associated with more infections in KTx and LTx recipients, this association has not been confirmed in all previous studies . We did not find such an association in our cohort, despite a comprehensive evaluation for infections.…”

Section: Discussioncontrasting

confidence: 97%

Neutropenia in kidney and liver transplant recipients: Risk factors and outcomes

Mavrakanas

Fournier

Clairoux

et al. 2017

Clinical Transplantation

View full text Add to dashboard Cite

No studies have directly compared the key characteristics and outcomes of kidney (KTx) and liver transplantation (LTx) recipients with neutropenia. In this single-center, retrospective, cohort study, we enrolled all adult patients who received a KTx or LTx between 2000 and 2011. Neutropenia was defined as 2 consecutive absolute neutrophil count (ANC) values <1500/mm in patients without preexisting neutropenia. The first neutropenia episode occurring during the first year post-transplantation was analyzed. A total of 663 patients with KTx and 354 patients with LTx met the inclusion criteria. Incidence of neutropenia was 20% in KTx and 38% in LTx, respectively. High-risk CMV status and valganciclovir (VGCV) use were significant predictors of neutropenia for KTx recipients, but only VGCV use vs nonuse in LTx recipients. Neutropenia was associated with worse survival in KTx recipients (adjusted HR 1.95, 95% CI 1.18-3.22, P<.01), but not in LTx recipients (adjusted HR 0.75, 95% CI 0.52-1.10, P=.15). Sixteen acute rejection episodes were associated with preceding neutropenia in KTx recipients (HR 1.77, 95% CI 1.16-2.68, P=.007) and 24 acute rejection episodes in LTx recipients (HR 1.41, 95% CI 0.97-2.04, P=.07). Incidence of infection was similar in patients with and without neutropenia among KTx and LTx recipients.

show abstract

Section: Discussioncontrasting

confidence: 97%

Neutropenia in kidney and liver transplant recipients: Risk factors and outcomes

Mavrakanas

Fournier

Clairoux

et al. 2017

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…We found no differences in leukopenia, neutropenia, or drug discontinuation rates between groups. The majority of leukopenia was seen within the first 6 months post transplant, overlapping with valganciclovir prophylaxis and the effects from alemtuzumab induction …”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of valganciclovir prophylaxis in high‐risk (D+/R−) renal transplant recipients experiencing delayed graft function

Freedman

Ravichandran

Masters

et al. 2019

Transplant Infectious Dis

View full text Add to dashboard Cite

Background Cytomegalovirus (CMV) outcomes with valganciclovir prophylaxis in renal transplant recipients experiencing delayed graft function (DGF) are unclear. Methods This single center, retrospective, cohort study of CMV high‐risk (D+/R− with alemtuzumab induction) deceased donor renal transplant recipients receiving valganciclovir prophylaxis assessed CMV outcomes in patients experiencing DGF (n = 72) versus those with immediate graft function (IGF; n = 66). Results Cytomegalovirus viremia by 12 months occurred at similar rates in the IGF and DGF groups (30.3% vs 26.4%, respectively, P = 0.71) with 89.7% (35/39) of all cases classified as CMV disease. The median time to CMV viremia post transplant was day 141 and 138 in the IGF and DGF groups, respectively (P = 0.30). The incidence of biopsy‐proven acute rejection (BPAR) was higher in the DGF group (18.1% vs 4.6%, P = 0.02) with BPAR preceding CMV in only 1 patient. There was no significant difference in graft loss (1.5% vs 4.2%, P = 0.62) or patient survival (98.5% vs 95.8%, P = 0.62) at 1 year between the IGF and DGF groups, respectively. Conclusion Valganciclovir prophylaxis in patients experiencing DGF yielded similar CMV outcomes up to 1‐year post transplant when compared to use in patients with IGF.

show abstract

“…The incidence of leucopenia in KTR has been reported as 33.3% and 42% in various studies [ 70 , 71 ]. The combined incidence of leucopenia and neutropenia is 47% [ 72 ]. Alemtuzumab causes more myelosuppression than ATG [ 70 , 71 ], with the lowest white cell count being observed approximately 130 days after the last administered dose [ 72 ].…”

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

View full text Add to dashboard Cite

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.

show abstract

Incidence and Management of Leukopenia/Neutropenia in 233 Kidney Transplant Patients Following Single Dose Alemtuzumab Induction

Cited by 24 publications

References 22 publications

Neutropenia in kidney and liver transplant recipients: Risk factors and outcomes

Neutropenia in kidney and liver transplant recipients: Risk factors and outcomes

Clinical outcomes of valganciclovir prophylaxis in high‐risk (D+/R−) renal transplant recipients experiencing delayed graft function

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

Contact Info

Product

Resources

About