Leukopenia is common in renal transplant recipients (RTRs), and is often managed by dose reduction of causative immunosuppressants, which may in turn increase the risk of rejection. The incidence of leukopenia in RTRs and its impact on short and long term transplant outcomes have not been widely studied.

Incidence of grade 2 or greater leukopenia using the Common Terminology Criteria scale (WBC < 3000/mm3) at two consecutive readings was analyzed. Among those who developed leukopenia (as defined above), the incidence of acute rejection, graft loss, and patient survival at both year 1 and year 3 post-transplant were compared to those without leukopenia.

Among 178 RTRs, 28.7% developed early leukopenia within 3 months of transplant, 51% of which was related to thymoglobulin. The incidence of leukopenia at year 1 and year 3 post-transplant were 29.8% and 33.7%, respectively, and the majority of patients (63%) experienced grade 3 or 4 leukopenia within 3 years post-transplant. The incidence of graft loss, death, acute cellular rejection, and antibody rejection rates at both 1 year and 3 years post-transplant among patients who developed leukopenia were not different from those who did not have leukopenia (table 1).

However, the total daily dose of mycophenolate was significantly lower in patients with leukopenia. Leukopenic patients were less likely to remain free of steroids and had higher levels of tacrolimus at 1 year and 3 years post-transplant, potentially due to attempts to make up for the higher risk of rejection related to lower doses of mycophenolate.

One third of RTRs are likely to develop leukopenia within 3 years of transplantation. Despite a difference in mycophenolate dosing, there were no differences in transplant outcomes at years 1 and 3.

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