S KUO1, M JOSE1,2, L JEFFS1, G KIRKLAND1, S YEW1, R YU1
1Royal Hobart Hospital, Hobart, Australia, 2School of Medicine, University of Tasmania, Hobart, Australia
Aim: To determine the incidence of post kidney transplant neutropaenia in Southern Tasmania, its effect on outcome and identify factors associated with increased risk of neutropaenia.
Background: Post-transplant neutropaenia is common and has been associated with poor outcomes. Nonetheless, the optimal management strategy and factors associated with neutropaenia remain unclear.
Methods: A retrospective study was performed on patients (>18 years) who received kidney or kidney-pancreas transplant between 2007-2017. Incidence of and clinical parameters surrounding neutropaenia (<1500 cells/microL) were determined. Pre-transplant parameters and outcome at one year post-transplant were compared to those who did not become neutropaenic.
Results: Of the 105 people who received a transplant (54% male, mean age 49), 54 (51%) first became neutropaenic at a mean time of 115 days post-transplantation with 26% experiencing more episodes subsequently. Post-transplant neutropaenia is associated with increased incidence of infection (68% vs 37%, p<0.05) and infection-related hospital admissions (49% vs 6%, p<0.05). There was a non-statistically significant association with more frequent rejection. CMV positive to negative transplant was associated with increased risk of post-transplant neutropaenia (38% vs 14%, p<0.05). Immunosuppression dose, Trimethoprim/Sulfamethoxazole use and Valgancyclovir use the time of neutropaenia was similar in both groups. There was no statistical significant association found in age at transplantation, gender, previous immunosuppression, type of donor, presence of donor specific antibody, human leukocyte antigen mismatch, ABO compatibility or delayed graft function. Clinician response varied often involving adjustment of multiple medications.
Conclusions: Post-transplant neutropaenia is common and is associated with increased rate of infection with the main risk factor identified being CMV positive to negative transplant.
Renal registrar at Royal Hobart Hospital