Authors: Rachel BeckerCohen Efrat BenShalom Choni Rinat Sofia Feinstein Michael Geylis Yaacov Frishberg
Publish Date: 2015/05/21
Volume: 30, Issue: 11, Pages: 2029-2036
Abstract
Infections are an important cause of morbidity and mortality in solid organ transplant recipients Neutrophils play a crucial role in the initial host defense against bacterial pathogens Neutropenia is not uncommon after renal transplantation in adults however there are scarce published data in children We conducted a historical cohort study to evaluate the incidence clinical course and management of severe neutropenia after renal transplantation in childrenIn a singlecenter study we collected clinical and laboratory data on all children 20 years who underwent renal transplantation from January 2005 to March 2014 All posttransplantation blood counts were reviewed the lowest absolute neutrophil count was recorded and correlated with clinical information and other laboratory findingsOf the 72 patients studied 46 64 had at least one episode of neutropenia absolute neutrophil count ANC 1500/μl during the study period 16 of whom 22 had severe neutropenia ANC 500/μl 2–11 months median 35 after renal transplantation Workup for viral infection or malignancy was performed Initial management included dose decrease and subsequent discontinuation of antimetabolite stopping cotrimoxazole and valganciclovir Bone marrow aspiration in four children revealed normal marrow cellularity in all cases with myelocyte maturational arrest in two Eight children 11 were treated with granulocyte colonystimulating factor GCSF 5 mcg/kg/day 1–4 doses median 2 with excellent response in all and no adverse effects Eight children presented with fever during severe neutropenia and were treated with empiric antibiotics Mycophenolate/azathioprine were resumed in all patients unless contraindicated preexisting BK viremia 1 PTLD 1 Recurrence of neutropenia was seen in five patients only one of whom required further treatment with GCSF Graft function was preserved during and after resolution of neutropeniaPosttransplant neutropenia in children is common and mostly occurs in the first few months Its etiology is probably primarily a result of the combination of immunosuppressive agents and prophylactic treatment of infections in the early posttransplant period
Keywords: