Z Gastroenterol 2005; 43 - 102
DOI: 10.1055/s-2005-869749

Leucopenic renal transplant recipient effectively treated with recombinant human granulocyte colony-stimulating factor without increasing the incidence of rejection

H Podder 1, B Forgacs 1, V Pollard 1, Z Csapo 1, R Knight 1, B Kahan 1
  • 1Division of Immunology and Organ Transplantation, University of Texas, Houston

Background: Leukopenia is a common adverse effect of immunosuppressive drugs, and increases the risk of infection in graft recipients. Recombinant human granulocyte colony-stimulating factor (rhG-CSF) is widely used in leukopenic patients. However some data suggested that it increases the incidence of acute rejection in organ transplant patients.

Objective: To evaluate the safety and efficacy of rhG-CSF in leukopenic renal transplant patients.

Material and methods: From January 1. 2002- December 31. 2004 259 kidney transplantations were performed. The induction was either with Anti Thymocyte Globulin-thymoglobuline (ATG) or with basiliximab (Simulect). The maintenance immunosuppression utilized Rapamycin (Rapa), Cyclosporine (CSA) and early withdrawal of corticosteroids. Mild rejection was treated with corticosteroids, moderate and severe rejection with ATG. 37 episodes of severe leukopenia (WBC <2000/mm3) developed in 26 patients, who were treated by rhG-CSF. Chart review was performed to determine the cause and duration of leukopenia, white blood counts (WBC) before and after treatment, occurrence of infection and incidence of rejection.

Results: Thymoglobuline (group 1) induced leukopenia in 20 and Rapamycin with cyclosporine (group 2) in 17 cases. The WBC counts after rhG-CSF treatment was significantly higher (10.9±5.6 vs. 7.9±2.3), the duration of leukopenia shorter (1.3±1.4 vs. 2.7±2) and the cumulative dose of rhG-CSF less (412±265 vs. 734±160) in group1 than in group 2 (p<0.05 in all cases). One infection occurred in group 1 and six in group 2. No rejection episode was observed during rhG-CSF treatment or within 1 month post therapy.

Conclusion: 1, rhG-CSF can be used safely and effectively in leukopenic renal transplant patients. 2, It appears to be more effective in patients with leukopenia induced by ATG than Rapamycin and CSA. 2, The incidence of acute rejection did not increase during the treatment.