Treatment of neutropenia in a renal transplant recipient with granulocyte colony-stimulating factor
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Transplantation Brief report
Treatment of neutropenia in a renal transplant recipient with granulocyte colony-stimulating factor Nadeem E. Moghal1, David V. Milford1, and P. Darbyshire2 1 2
Department of Nephrology, The Birmingham Children's Hospital, Ladywood Middleway, Ladywood, Birmingham B16 8ET, UK Department of Haematology, The Birmingham Children's Hospital, Ladywood Middleway, Ladywood, Birmingham B16 8ET, UK
Received December 17, 1996; received in revised form August 7, 1997; accepted August 12, 1997
Abstract. We report the use of granulocyte colony-stimulating factor (G-CSF) in a renal transplant recipient in whom neutropenia developed following a presumed viral infection. G-CSF was successful in producing a rise in neutrophil count which coincided with a resolution of fever; there was no adverse effect on renal function. This is the first use of G-CSF in a paediatric renal transplant recipient, and its use should be considered for the immunosuppressed child with persistent neutropenia. Key words: Neutropenia ± Granulocyte colony-stimulating factor ± Renal transplant Fig. 1. Neutrophil response to granulocyte colony-stimulating factor (G-CSF)
Introduction Persistent neutropenia in an immunosuppressed transplant recipient is of concern. Although granulocyte colonystimulating factor (G-CSF) is being increasingly used in patients with neutropenia of various aetiologies [1 ± 3], there is no report of the use of this therapy in paediatric renal transplant recipients with neutropenia. We report our successful use of G-CSF (Lenograstim-Chugai Pharma UK) in a child with symptomatic neutropenia 8 months following a cadaveric renal transplant. Case report A male child with dysplastic kidneys had renal impairment from birth. At 22 months of age he received a cadaveric transplant and was immunosuppressed with prednisolone, azathioprine and cyclosporin. Both recipient and donor were cytomegalovirus negative. The initial transplant function was good and the plasma creatinine fell to 50 mmol/l by day 7. The first episode of acute rejection occurred 1 month after transplantation and was confirmed histologically. This
Correspondence to: N.E. Moghal
resolved after treatment for 5 days with intravenous methylprednisolone at a dose of 10 mg/kg per day. Two further rejection episodes occurred 2 and 4 months after transplantation. Following the third episode, tacrolimus was substituted for cyclosporin. Following an upper respiratory tract infection 8 months after transplantation, the child developed anaemia and leucopenia (haemoglobin 8.9 g/dl, white cell count 1.8´109/l, neutrophils 0.4´109/l). The platelet count remained normal. Azathioprine was stopped for a week and, following an improvement in the total white cell count (3´109/l), was recommenced at half the previous dose. The neutropenia persisted and because the total white cell count declined, azathioprine was stopped once more. He was admitted with a febrile illness 1 week later, but no focus of infection was found; serology for cytomegalovirus, herpes simplex vi
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