Cytopenias in Pediatric Kidney Transplant Recipients: Risk Factors and Clinical Consequences

Abstract

Abstract Purpose: To evaluate the characteristics of cytopenias in pediatric kidney transplant recipients (KTRs), identify predictors and assess management and consequences. Methods: A retrospective, single-center, case-control study of pediatric KTRs between the years 2000-2019. Possible risk factor for cytopenias were compared in multivariate Cox regression, with the aim of finding predictors for post-transplant thrombocytopenia (PTT) and post-transplant neutropenia (PTN). PTNs were analyzed for the total study period, and for the period beyond 6-months post-transplant (late PTNs), to rule-out the confounding influence of induction and initial intensive therapy.Results: 89 children were included in the study. Prevalence of PTT was 22%, all cases were mild or moderate. Post-transplant infections and graft rejection were found to be significant risk factors for PTT (HR 6.06, 95% CI 1.6-22.9, and HR 5.82, 95% CI 1.27-26.6, respectively). Overall PTN prevalence was 60%; 30% were severe (ANC ≤ 500(. Pre-transplant dialysis and post-transplant infections were significant predictors for late PTN (HR 11.2, 95% CI 1.45-86.4, and HR 3.32, 95% CI 1.46-7.57, respectively). Graft rejection occurred in 10% of KTRs with cytopenia, all following neutropenia, within 3 months from cytopenia appearance. In all such cases, mycophenolate mofetil dosing had been held or reduced prior to the rejection. One case resulted in graft-loss. Conclusions: Post-transplant infections are substantial contributors for developing PTTs and PTNs. Pre-emptive transplantation appears to reduce risk for late PTN, the accompanying reduction in immunosuppressive therapy and the ensuing risk for graft rejection. An alternative response to PTN, possible with granulocyte colony stimulating factor (G-CSF), may diminish graft loss.