Purpose: Leukopenia is a frequent complication in renal transplant recipients (RTRs). Granulocyte colony-stimulating factor (G-CSF) accelerates white blood cell (WBC) count recovery; but, published experience with G-CSF in RTRs is limited. Methods: We conducted a single-center retrospective review of RTRs (including multi-organ RTRs) from Jan 2012-Sept 2016 with G-CSF ordered for leukopenia (defined as WBC < 3000 cells/mm³) within 6 months post-op. WBC count recovery was defined as WBC ≥ 3000 cells/mm³. RTRs were followed for 3 months after G-CSF order. Results: Forty-one RTRs met inclusion criteria. Mean (SD) age at RT was 56±12 years, 58.5% were female and 68.3% were white. The cohort included 36 RTRs, 1 pancreas-RTR, 3 liver-RTRs, and 1 heart-RTR. Most (80.5%) received a deceased donor transplant, 24.4% had cPRA > 20%, 36.6% had DGF, and 46.3% had donor-positive/recipient-negative CMV status. Induction therapy included rabbit-ATG in 87.8% of RTRs (mean total dose 4.8±1.6 mg/kg). Mean time from RT to G-CSF initiation was 94±42 days. At G-CSF initiation, mean WBC and absolute neutrophil count (ANC) were 1260±400 and 650±390 cells/mm³, respectively. Mean G-CSF dose ordered was 4.55 mcg/kg/dose with a mean total 11.3±13.3 mcg/kg administered during leukopenia. Of 28 RTRs who received G-CSF as outpatients, 78.6% required prior authorization leading to therapy delays, and 6 had WBC count recovery before G-CSF was obtained. Mean time to WBC count recovery was 16±26 days after the first G-CSF dose. Dose adjustment/discontinuation of RTR medications due to leukopenia was also common (Table 1).

Within 3 months after leukopenia onset, 2 RTRs had biopsy-proven rejection and 16 (39%) developed infections requiring hospitalization or had opportunistic infections. Conclusion: G-CSF can help achieve WBC count recovery in RTRs with leukopenia. Delays in outpatient G-CSF administration were common, so insurance approval should be pursued early. Changes to other RTR medications may also impact WBC count recovery. Prospective studies are needed to determine optimal G-CSF dosing in RTRs.

CITATION INFORMATION: Hamel S., Kuo V., Johnson D., Bloom R., Sawinski D., Trofe-Clark J. Use of Granulocyte Colony-Stimulating Factor for Leukopenia Post-Renal Transplant Am J Transplant. 2017;17 (suppl 3).

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