Burden of neutropenia and leukopenia among adult kidney transplant recipients: A systematic literature review of observational studies. Issue 1 (19th January 2023)

• Record Type: Journal Article
• Authors: Raval, Amit D.; Kistler, Kristin D.; Tang, Yuexin; Vincenti, Flavio
• Is Part Of: Transplant infectious disease. Volume 25:Issue 1(2023)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2023-01-19
• Subjects: kidney transplantation -- leukopenia -- neutropenia; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.14000
• Languages: English
• ISSNs: 1398-2273

Abstract

Abstract: Background: Leukopenia and neutropenia (L/N) may affect treatment decisions, potentially resulting in poor clinical and economic outcomes among kidney transplant recipients (KTRs). The burden of L/N is poorly quantified systematically. This systematic literature review aimed to summarize the incidence of, risk factors for, and clinical and economic outcomes associated with L/N post‐KT. Methods: We systematically searched MEDLINE, Embase, and the Cochrane Library (from database inception‐June 14, 2021) and conferences (past 3 years) to identify observational studies examining epidemiology, risk factors, or outcomes associated with L/N among adult KTRs. Results: Of 2081 records, 82 studies met inclusion criteria. Seventy‐three studies reported the epidemiology of L/N post‐KT. Pooled incidence of neutropenia, defined as absolute neutrophil counts (ANC) <1000/μl, ranged from 13% to 48% within 1‐year post‐transplant; ANC <500/μl ranged from 15% to 20%. Leukopenia, defined as white blood cell counts <3500/μl, was 19% to 83%. Eleven studies reported independent risk factors associated with L/N post‐KT. D+/R− cytomegalovirus status, mycophenolic acid (MPA), and tacrolimus use were the most consistent risk factors across studies. Fourteen studies reported L/N‐associated clinical outcomes. We noted a trend toward a positive association between neutropenia and acute rejection/opportunistic infections. Mixed findings were noted on the association between L/N and graft failure or mortality. Dosage modifications of valganciclovir, MPA, cotrimoxazole, and anti‐thymoglobulin and the need for granulocyte colony‐stimulating factor (G‐CSF) use were common with L/N. Conclusion: Findings suggest post‐transplant L/N were common and associated with frequent modifications of immunosuppressive agents, requiring G‐CSF use, and rejection or opportunistic infections. Findings highlight the need for interventions to reduce risk of L/N post‐KT. Abstract :