Session Name: All Infections (Excluding Kidney & Viral Hepatitis)
Session Date & Time: None. Available on demand.
*Purpose: The incidence of leukopenia and neutropenia in solid organ transplant (SOT) recipients can be influenced by medications required after transplant for immunosuppression and infection prophylaxis. This may lead to providers altering doses of immunosuppressant and infection prophylaxis medications which may increase the risk of clinical consequences such as graft rejection, mortality, and infections. Further research is warranted to assess the incidence of clinical consequences in patients developing cytopenias within 12 months of transplant.
*Methods: This retrospective, single center chart review performed at our institution included patients 18 to 89 years old who received a SOT between August 2016 to November 2017. The primary endpoint was the incidence of clinical consequences between groups within 12 months after transplant. Secondary endpoints included cumulative days of mycophenolate dose reduction or discontinuation as well as mycophenolate and valganciclovir dose adjustments in response to a cytopenic event.
*Results: Out of the 179 records included, the most common type of organ transplant was lung and kidney. No differences in induction and maintenance immunosuppression were noted between groups. A trend towards lower monthly total mycophenolate doses was observed in the leukopenia only and neutropenia groups. No differences in acute rejection (13.5% vs. 13.6% vs. 14.4%; p=0.879), bacterial infection (56.8% vs. 67.8% vs. 51.8%; p=0.161), or patient survival (97% vs. 100% vs. 97%; p= 0.254) were noted between groups. Prescribers commonly held or decreased the dose of mycophenolate while continuing valganciclovir in response to an episode of cytopenia. Patients with neutropenia more frequently developed cytomegalovirus (CMV) infection than other groups (2.7% vs. 23.7% vs. 9.6%; p=0.006) after the event, however only 1 patient developed CMV infection after holding valganciclovir.
|Leukopenia only (N= 37)||Neutropenia (N= 59)||Neither leukopenia or neutropenia (N= 83)||p-value|
|Age (years), median [IQR]||63 [50-69.5]||65 [57-71]||64 [52-69]||0.409|
|Male gender, n (%)||29 (78.4)||31 (52.5)||58 (69.9)||0.020|
|Type of transplant, n (%) Kidney; Single lung; Double lung||12 (32.4); 13 (35.1); 7 (18.9)||10 (16.9); 26 (44.1); 14 (23.7)||20 (24.1); 26 (31.3); 22 (26.5)||0.139|
|Mycophenolate held at event, n (%)||12 (32.4)||21 (35.6)||—||—|
|Cumulative days of mycophenolate dose reduction or discontinuation, median days||43||73||—||—|
|Valganciclovir continued at event, n (%)||33 (89)||39 (65)||—||—|
*Conclusions: This data may suggest that holding or decreasing mycophenolate for a moderate duration in our population did not increase the rate of acute rejection. The occurrence of a leukopenic or neutropenic event did not appear to increase the rate of bacterial infection, but close monitoring for CMV infection may be warranted.
To cite this abstract in AMA style:Diamond A, Diehl N, Hiryak K, Mortia K, Au J, Ruggia-Check C, Clauss H. Clinical Consequences in Patients Experiencing Leukopenia and Neutropenia After Solid Organ Transplant [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/clinical-consequences-in-patients-experiencing-leukopenia-and-neutropenia-after-solid-organ-transplant/. Accessed December 7, 2021.
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