Single Center, Real-World Experience with Granulocyte Colony-Stimulating Factor for Management of Leukopenia Following Kidney Transplantation.

Background Leukopenia is a frequent complication following kidney transplantation. Granulocyte colony-stimulating factor (G-CSF) has been used to accelerate white blood cell (WBC) count recovery; however, published experience in kidney transplantation is limited. Methods We retrospectively reviewed our kidney transplant recipients from January 2012 to September 2016 with a G-CSF order to evaluate leukopenia management (defined as WBC <3000 cells/mu L). Results Thirty-six recipients were included. On average, G-CSF treatment began at 98 +/- 38 days. At G-CSF initiation, mean WBC count was 1240 +/- 420 cells/mu L and absolute neutrophil count (ANC) was 653 +/- 368 cells/mu L. Mean G-CSF dose was 4.6 +/- 1.2 mcg/kg/dose (total 11.8 +/- 9.0 mcg/kg), 77.8% of recipients were prescribed G-CSF as outpatients, and overall, median time to WBC count recovery was 9 (IQR 4-14) days. Changes in immunosuppression and prophylaxis regimens for leukopenia were also common. Within 1 month following leukopenia onset, no patients experienced acute rejection and 5 (14%) developed infection requiring hospitalization or opportunistic infection. Conclusion In kidney recipients with leukopenia, G-CSF may be helpful to achieve WBC count recovery in addition to changes in immunosuppression and prophylaxis medications. Prospective, randomized data are still needed to determine optimal G-CSF dosing in this population.