*Purpose: Older kidney transplant recipients face challenges of post-transplant complications related to frailty and comorbidity burden. They are particularly vulnerable to side effects of immunosuppression including leukopenia and infections. This study explores common practices of providers to address leukopenia and/or neutropenia in older recipients.

*Methods: We performed a retrospective cohort study of 176 kidney transplant recipients age ≥ 60 yrs, who underwent kidney transplantation between 2007 and 2015 and subsequently developed leukopenia (WBC < 3 or <2k/cumm) or neutropenia (ANC <1 or <0.5 k/cumm). Severe infection was defined as those necessitating hospitalization and/or Immunosuppression reduction. Manual chart abstraction was conducted to determine medication changes and concurrent infections during the time period of leukopenia. Analyses were conducted using univariate statistics.

*Results: The rate of overall leukopenia was 42.9% (176 of 410 patients).Table 1 displays the clinical approach to leukopenia and rates of infection. G-CSF utilization increased from 26% in mild cases to 73% in the most severe cases of neutropenia (ANC <0.5). MMF was dose-reduced in 58-85% of cases. Holding Valganciclovir and TMP-SMX was also a common strategy utilized when patients were still on infectious prophylaxis. The prevalence of severe infections, some with multiple infectious foci, increased with worsening leukopenia, but interestingly not with worsening neutropenia.

*Conclusions: Older kidney transplant recipients often face challenges of leukopenia, occasionally associated with infection. Clinicians’strategies to manage leukopenia varied quite substantially and need to be streamlined in order to mitigate infectious risks without increasing risk of rejection from under immunosuppression.

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