SAT-331 HEMATOLOGICAL ABNORMALITIES IN FIRST THREE MONTHS POST RENAL TRANSPLANTATION: A SINGLE CENTRE STUDY FROM NORTH EAST INDIA

Abstract

Renal transplantation(RT) in renal failure improves patients' quality of life. 20%–63% of RT recipients will experience at least one episode of leukopenia. RT recipients show the lowest platelet count within the first 3 months after transplantation. It is in this period that patients receive induction therapy and higher doses of conventional immunosuppressive drugs to prevent or treat acute rejection. Cytopenia may result due to drug toxicity, drug interactions, viral infections, or immune-mediated reactions. Several drugs may cause cytopenia within the 1st month after RT. Discontinuation or substitution of offending drugs will be helpful in treating thrombocytopenia. Leukopenia in transplanted patients increases the risk of infection. In drug induced cytopenia, the most effective measure is dose reduction or discontinuation of precipitant drug; however, this strategy may increase the risk of acute rejection. Objective: This study assessed incidence, etiology and severity of various forms of hematological abnormalities within the first three months after kidney transplantation. This retrospective study was conducted on kidney transplant recipients from Guahati Medical College and Hospital, Assam for 5 years from Jan'13 to Dec'18. Demographic, clinical, and laboratory data of patients within the first three months after transplantation were collected and reviewed. Strategies like medication dose adjustment, cytomegalovirus infection or G-CSF administration for management of drug-induced leukopenia and thrombocytopenia were also reviewed. Inclusion criteria: All kidney transplant recipients. Exclusion criteria: Patients without voluntary written consent, known haematological disease and thrombocytopenia due to ABMR. 44 kidney transplant recipients (37 males and 7 females) with mean age of 33.4 ±14.4 years old who met the inclusion criteria were enrolled in this study. The most common causes of renal failure among these patients were CGN(38.1% of cases), DM (33.5% of cases), chronic tubulointestitial disease (20.4%) and hypertension (8%). Of these 44 patients, 7 (15.93%) received rATG, 5 (11%) IL2R as induction therapy. All patient received IS agents consisting of CSA/Tacrolimus, MMF and steroid. There wasno significant difference between these groups regarding demographic and clinical data. Sulfamethoxazole and trimethoprim and VGV were routinely given to all recipients as prophylaxis. Of 44 patients, 5(11.3%), 16(36.3%) and 7(15.9%) patients experienced leucopenia, thrombocytopenia and pancytopenia respectively. Leucopenia occurred more commonly among patients with thymoglobulin-containing regimen. Pancytopenia was observed in patients who received rATG, MMF, VGV and TMP-SMX. 5 patients received basiliximab as induction agent and did not develop cytopenia. The total administered dose of rATG in patients with leukopenia showed no significant difference in comparison to patients without leucopenia. Hematological abnormalities are not an uncommon feature amongst kidney transplant recipients. Choice of appropriate induction therapy, immunosupressive agent and prophylactic agents can minimize the hematological abnormalities in kidney transplant recipients.