Tacrolimus-induced leukopenia in a kidney transplant recipient: A case study

Abstract

Introduction: Leukopenia occurs in 10%-55% of patients after kidney transplant and neutropenia occurs in approximately 28% of patients after kidney transplant. Resolution of leukopenia and neutropenia is done through treatment of the pathogen, such as cytomegalovirus, or removing the offending medication. Medications that are first thought to contribute to leukopenia include Valganciclovir, Sulfamethoxazole-Trimethoprim, and Mycophenolic Acid. Tacrolimus rarely contributes to leukopenia and neutropenia post kidney transplantation.

Case presentation: This case study presents a patient who developed leukopenia and neutropenia 13 weeks after solitary kidney transplantation.

Management: Mycophenolate Mofetil, Valganciclovir, Ergocalciferol, Aspirin, Famotidine, and Sulfamethoxazole-Trimethoprim were all discontinued. Filgrastim was used intermittently to increase white blood cell count. Ultimately, Tacrolimus was switched to Cyclosporine.

Outcome: Leukopenia was resolved by switching Tacrolimus to Cyclosporine-based immunosuppression.

Discussion: A systematic approach should be taken to resolve leukopenia post-kidney transplant. When a kidney transplant recipient is on Tacrolimus-based immunosuppression, Tacrolimus should be the last medication changed when attempting to resolve leukopenia.