SAT-448 CYTOPENIA IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD): JUST AN ASSOCIATION OR DISEASE-RELATED FEATURE WITH PROGNOSTIC IMPLICATIONS?

Abstract

Autosomal dominant polycystic kidney disease (ADPKD), the most common monogenetic inherited kidney disease, appears to be associated with distinct cytopenias in observational studies. The strongest association is seen with lymphopenia and this through all stages of chronic kidney dysfunction. As to the mechanism behind this association, no satisfying explanation is available to date nor is the potential prognostic impact of the cytopenias noted. We compared blood cell counts between ADPKD-and non-ADPKD in a cohort of patients with end-stage renal disease at the day before kidney transplantation and at 1 year after kidney transplantation. Data was extracted retrospectively from the prospective renal transplantation database of the University Hospitals of Leuven, Belgium. Patients who underwent second or third transplantation or with graft survival less than 1 year were excluded. We compared clinical characteristics and biochemical date from the day before and at 1 year after transplantation. 502 patient with ADPKD and 2597 patients without ADPKD were included. Pre-transplant a significant difference between the two groups was found for total leukocyte count (6.28x10**9/L (+/-0.09SD) in ADPKD versus 7.14x10**9/L (+/-0.05 SD) in non-ADPKD patients; p-value: <0.0001), neutrophil count (4.04x10**9/L (+/-0.08 SD) versus 4.53x10**9/L (0.04 SD); p-value: <0.0001) and total lymphocyte count (1.40x10**9/L (+/- 0.03 SD) versus 1.57x10**9/L (+/- 0.02 SD); p-value: <0.0001). Comparison of the two cohorts at 1 year post-transplant showed a significant difference in neutrophil (4.16x10**9/L (+/-0.10 SD) versus 5.02x10**9/L (+/-0.05 SD); p-value: <0.0001) and lymphocyte (1.54x10**9/L (+/- 0.04 SD) versus 1.83x10**9/L (+/- 0.07 SD); p-value: 0.032) counts. Total leukocyte count was not significantly different at 1 year post-transplant (6.40x10**9/L (+/- 0.10 SD) versus 9.25x10**9/L (+/- 1.74 SD); p-value: 0.434). ADPKD is associated with lower total leukocyte, neutrophil and lymphocyte counts as compared to non-ADPKD in a large cohort of patients with end-stage renal disease at the time of kidney transplantation. The differences between groups persist at 1 year post-transplant. Further analysis of this cohort will allow us to explore the prognostic impact of findings. In-dept research will need to focus on whether cytopenia is a yet unrecognized systemic feature of ADPKD or can be explained by other mechanisms.