*Purpose: Leukopenia/neutropenia (L/N) may affect key treatment decisions which could result in poor clinical and economic outcomes among kidney transplant recipients (KTRs). The burden of these myelosuppressive events is poorly quantified systematically. We conducted a systematic literature review to summarize the incidence of, risk factors for, and clinical outcomes associated with, L/N post-KT.

*Methods: We systematically searched MEDLINE, Embase, and the Cochrane Library (from database inception to June 14, 2021) and conferences for the past three years to identify the studies for inclusion. We included observational studies examining epidemiology, risk factors, or outcomes associated with L/N among adult KTRs.

*Results: Of 2,078 retrieved records, 79 studies met inclusion criteria. Most studies were retrospective cohort (86%) and from North America (48%) and Europe (28%). A total of 70 studies reported the epidemiology of L/N post-KT. Neutropenia defined as absolute neutrophil counts (ANC) <1000/µl ranged from 11% to 48% within 1-year post-transplant; and ANC < 500/µl ranged from 1.3% to 15%; whereas leukopenia defined as white blood cell counts (WBC) <3500/µl ranged from 19% to 83%. Ten studies reported risk factors associated with L/N post-KT using multivariable regression analysis. D+/R- CMV status, mycophenolic acid (MPA), and tacrolimus use were reported as the most consistent risk factors across the studies. Twelve studies reported L/N-associated clinical outcomes. We noted a trend towards a positive association between neutropenia and acute rejection/opportunistic infections. Mixed findings were noted on the association between L/N and graft failure or mortality. Dosage modifications (reduction/interruption/discontinuation) of valganciclovir, MPA, cotrimoxazole, anti-thymoglobulin and the need for G-CSF use were common among KTRs with L/N.

*Conclusions: Our findings suggest that post-transplant L/N were common and associated with frequent modifications of immunosuppressive agents, requiring G-CSF use and rejection or opportunistic infections. Findings highlight the need for interventions to reduce the risk of L/N among adults KTRs.

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