Cytomegalovirus Infection Associated Neutropenia and Acute Kidney Graft Rejection

Abstract

Background: Cytomegalovirus (CMV) infection, neutropenia occurrence and mycophenolate (MMF) dose reduction are associated with an increased risk of acute kidney graft rejection. The aim of our retrospective clinical study was to evaluate the association of CMV associated neutropenia with a consequent MMF dose reduction and acute kidney graft rejection. Method: 161 patients transplanted from January 2005 till December 2010, who received anti-CD25 antibodies induction, MMF, calcineurin inhibitor and steroids, were retrospectively analyzed for the incidence of neutropenia (leucocyte count 150 virus copies/mL detected by polymerase chain reaction), MMF dose modification, granulocyte colony-stimulating factor (G-CSF) therapy and rejection episodes. Results: Neutropenia was detected in 41 (25.5%) patients. It was associated with CMV viremia (p<0.001) but not with CMV prophylactic therapy. MMF dose was reduced due to neutropenia in 29 patients (70.7%) and acute rejection occurred in 6 (14.6%) of them. The average reduction of MMF dose in these patients was 31% of the initial dose. All neutropenic patients with rejection had concomitant CMV infection. There was a trend to positive correlation between MMF reduction and CMV infection or rejection (p=0.06). G-CSF was used in 16 (39.02%) neutropenic patients. No significant correlation was found between G-CSF use and occurrence of acute rejection. Conclusion: CMV infection was important cause of neutropenia that resulted in MMF dose reduction and increased rate of acute graft rejection. G-CSF therapy is an alternative therapeutic approach in neutropenic patients that enables the maintenance of optimal therapeutic dose of MMF and without significant influence on acute rejection occurrence.