Down but Not Out: Leucopenia Can Be Safely Treated with Reduction in Immunosuppression without Increasing Risk to the Kidney Allograft.
1Department of Medicine, Medstar Georgetown Transplant Institute, Washington, DC
2Department of Surgery, Medstar Georgetown Transplant Institute, Washington, DC
Meeting: 2017 American Transplant Congress
Abstract number: A208
Keywords: Immunosuppression, Kidney transplantation, Neutropenia, Survival
Session Information
Session Name: Poster Session A: Kidney Complications I
Session Type: Poster Session
Date: Saturday, April 29, 2017
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
Introduction
Leucopenia is a growing problem with increasing immunosuppression (IS) in kidney transplantation. Reducing IS in the face of leucopenia is a concern due to the potential for increased immunologic events. We looked at our experience with reductions in immunosuppression for patients with leucopenia.
Methods
We retrospectively reviewed all kidney transplant recipients over the last 4 years at our center and stratified them by a series of variables including leucopenia, the need for IS reduction, their induction regimen and by demographic data. Differences between groups were analyzed using Fisher's exact test with a two tailed p value.
Results
586 patients were analyzed. 370 experienced leucopenia and 266 of those had a reduction in IS compared with 104 who did not require a reduction in IS. The reduction in IS was not associated with a significant increase in rejection or graft loss. The groups were well matched in all variables examined, although patients with leucopenia overall had a significantly lower use of basiliximab as an induction agent (p= 0.0003).
| Low WBC, Decreased IS | Low WBC, Normal IS | Normal WBC | Low WBC | |
| Number | 266 | 104 | 216 | 370 |
| Alemtuzumab | 75.2% | 80.8% | 71.3% | 76.8% |
| Thymoglobulin | 17.7% | 13.5% | 12.5% | 16.5% |
| Basiliximab | 7.1% | 5.8% | 16.2% p= 0.0003 | 6.8% |
| DDKs | 63.2% | 76.9% | 70.8% | 67.0% |
| 1st Transplants | 83.5% | 82.7% | 85.2% | 83.2% |
| Age at Transplant | 51 | 52 | 54 | 51 |
| Male | 59.8% | 61.5% | 61.1% | 60.3% |
| African American | 58.3% | 64.4% | 59.3% | 60.0% |
| Rejection Rate | 19.9% | 14.4% p= 0.23 | 17.6% | 18.4% p=NS |
| Graft Loss | 7.5% | 10.6% p= NS | 9.3% | 8.4% p=NS |
| Avg. Follow up | 691 days | 545 days | 571 days | 650 days |
Conclusion
Treatment of leucopenia with reduced IS can be accomplished safely regardless of induction therapy. The risks of immunosuppression reduction are small compared to the risks associated with the leucopenia itself.
CITATION INFORMATION: Gilbert A, Vergottini A, Karabala A, Grafals M, Javaid B, Moore J, Verbesey J, Abrams P, Ghasemian S, Cooper M. Down but Not Out: Leucopenia Can Be Safely Treated with Reduction in Immunosuppression without Increasing Risk to the Kidney Allograft. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Gilbert A, Vergottini A, Karabala A, Grafals M, Javaid B, Moore J, Verbesey J, Abrams P, Ghasemian S, Cooper M. Down but Not Out: Leucopenia Can Be Safely Treated with Reduction in Immunosuppression without Increasing Risk to the Kidney Allograft. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/down-but-not-out-leucopenia-can-be-safely-treated-with-reduction-in-immunosuppression-without-increasing-risk-to-the-kidney-allograft/. Accessed November 21, 2024.« Back to 2017 American Transplant Congress