Febrile neutropenia (FN) is a common complication in cancer patients receiving chemotherapy. Neutropenia is common after kidney transplant (KT), but little is known about the risk of FN after KT, the microbiology of FN after KT, or patient outcomes of FN after KT. We performed a retrospective analysis of cases of FN at our center from 2009-2016. Neutropenia was defined as absolute neutrophil count < 1000 and fever as T > 38.0 C. During the study period, 1710 patients received a KT. 52 patients (3.04%) had 55 FN episodes (FNE). Mean age was 51.1 years, 40.4% were female, 57.7% received a deceased donor KT. All patients received induction (37 thymo, 4 basiliximab. 11 Campath), early steroid withdrawal, and maintenance with tacrolimus and MMF. 30.8% had an episode of acute rejection prior to FNE.

FNE occurred a mean of 9.1 months after KT, with 43/55 (78%) cases in the first year after transplant. 37/55 (67%) FNE occurred <1 month after onset of neutropenia. No infectious organisms were found in 28/55 FNE, viral infection in 6/55 FNE (3 CMV, 2 adenovirus, 1 parvovirus), bacteria in 19/55 FNE (6 E. coli 2 Pseuodmonas, 7 Klebsiella, 2 Staph aureus, and 1 Bordetella) and Candida and MAC in 1 FNE each. Only 10 patients were taking full dose of MMF 6 months after FNE.

At last follow up (mean 38 months after FNE), 10/52 (19%) were dead (all with functioning graft), with 6/10 deaths occurring within 1 year of FNE; 9/52 (17%) had graft failure after FNE, with 3/9 graft failures within 1 year of FNE; and 33/52 (64%) were alive with functioning graft. 17/52 (33%) patients had rejection after FNE, with 11/17 (65%) cases occurring more than 1 year after FNE. 59% of patients with rejection after FNE were alive with functioning graft at last follow up, compared with 66% of patients without rejection after FNE.

Conclusion: An infectious source is often not identified in FNE after KT, and opportunistic infections are uncommon causes of FNE. There is a high rate of subsequent acute rejection in KT recipients after FNE. There is a high risk of allograft failure and death following FNE, and the risk persists for long after the neutropenia has resolved. Most patients were not placed back on full dose of MMF, and this may contribute to the increased risk of rejection and graft failure after FNE.

CITATION INFORMATION: Dube G., Husain S., Morris H., Cohen D., Mohan S. Microbiology and Outcomes of Febrile Neutropenia Episodes after Kidney Transplant Am J Transplant. 2017;17 (suppl 3).

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