Neutropenia in Kidney Transplantation: A Hidden Threat to Graft Survival.
Medstar Georgetown Transplant Institute, Washington, DC
Meeting: 2017 American Transplant Congress
Abstract number: 347
Keywords: Graft failure, Kidney transplantation, Neutropenia, Rejection
Session Information
Session Name: Concurrent Session: Kidney Clinical Complications 2
Session Type: Concurrent Session
Date: Monday, May 1, 2017
Session Time: 4:30pm-6:00pm
Presentation Time: 4:54pm-5:06pm
Location: E354b
Introduction
Neutropenia is a common complication after kidney transplantation resulting in a reduction of immunosuppression and the use of granulocyte colony-stimulating factors (G-CSF) which can increase the risk of rejection and allograft loss. Here we report our data on the risk of neutropenia to the allograft.
Methods
We conducted a retrospective, single center review involving 614 patients transplanted between April 1 2012 to April 1 2016. We analyzed the occurrence of neutropenia (absolute neutrophil count < 500/ul), the medical interventions and the rates of rejection and allograft loss.
Results
The final sample included 586 patients followed for an average of 2 years. Neutropenia occurred in 11% of cases. All neutropenic patients had a reduction in immunosuppression. The groups were generally homogeneous, but did differ in the percent of African Americans. However,in a multivariate analysis, there was no significant association between the probability of neutropenia and ethnicity, nor an association with age, gender, re-transplant status, or induction therapy. Deceased donor kidney transplants were the only significant association found. Neutropenia was associated with increased risk of rejection compared with non-neutropenic patients. Allograft loss was also greater in neutropenic patients compared with non-neutropenic patients. On average, allograft loss occurred 140 days after neutropenia. This graft loss occurred despite aggressive medical intervention at the time of neutropenia.
| No Neutropenia | Neutropenia | p value | |
| Number | 523 | 63 | |
| ACR Rate | 89 (17%) | 17 (27%) | 0.05 |
| Graft Loss | 42 (8%) | 11 (17%) | 0.01 |
| African American | 61% | 46% | 0.02 |
| Females | 39% | 40% | 0.96 |
| Age | 52 years | 51 years | 0.57 |
| DDKs | 68% | 71% | 0.59 |
| Basiliximab Induction | 10% | 14% | 0.26 |
Conclusion
Post-transplantation neutropenia is associated with both an increased risk of rejection as well as higher rates of allograft loss despite medical management. We conclude that treatment must be initiated before patients reach neutropenia if the graft is to be kept at low risk.
CITATION INFORMATION: Vergottini A, Karabala A, Abrams P, Verbesey J, Ghasemian S, Moore J, Grafals M, Javaid B, Cooper M, Gilbert A. Neutropenia in Kidney Transplantation: A Hidden Threat to Graft Survival. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Vergottini A, Karabala A, Abrams P, Verbesey J, Ghasemian S, Moore J, Grafals M, Javaid B, Cooper M, Gilbert A. Neutropenia in Kidney Transplantation: A Hidden Threat to Graft Survival. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/neutropenia-in-kidney-transplantation-a-hidden-threat-to-graft-survival/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress