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Burden of neutropenia and leukopenia among adult kidney transplant recipients: A systematic literature review of observational studies.
Raval, Amit D; Kistler, Kristin D; Tang, Yuexin; Vincenti, Flavio.
Afiliação
  • Raval AD; Merck & Co., Inc., Rahway, New Jersey, USA.
  • Kistler KD; Xcenda, Inc., Carrollton, Texas, USA.
  • Tang Y; Merck & Co., Inc., Rahway, New Jersey, USA.
  • Vincenti F; University of California, San Francisco, California, USA.
Transpl Infect Dis ; 25(1): e14000, 2023 Feb.
Article em En | MEDLINE | ID: mdl-36508475
BACKGROUND: Leukopenia and neutropenia (L/N) may affect treatment decisions, potentially resulting in poor clinical and economic outcomes among kidney transplant recipients (KTRs). The burden of L/N is poorly quantified systematically. This systematic literature review aimed to summarize the incidence of, risk factors for, and clinical and economic outcomes associated with L/N post-KT. METHODS: We systematically searched MEDLINE, Embase, and the Cochrane Library (from database inception-June 14, 2021) and conferences (past 3 years) to identify observational studies examining epidemiology, risk factors, or outcomes associated with L/N among adult KTRs. RESULTS: Of 2081 records, 82 studies met inclusion criteria. Seventy-three studies reported the epidemiology of L/N post-KT. Pooled incidence of neutropenia, defined as absolute neutrophil counts (ANC) <1000/µl, ranged from 13% to 48% within 1-year post-transplant; ANC <500/µl ranged from 15% to 20%. Leukopenia, defined as white blood cell counts <3500/µl, was 19% to 83%. Eleven studies reported independent risk factors associated with L/N post-KT. D+/R- cytomegalovirus status, mycophenolic acid (MPA), and tacrolimus use were the most consistent risk factors across studies. Fourteen studies reported L/N-associated clinical outcomes. We noted a trend toward a positive association between neutropenia and acute rejection/opportunistic infections. Mixed findings were noted on the association between L/N and graft failure or mortality. Dosage modifications of valganciclovir, MPA, cotrimoxazole, and anti-thymoglobulin and the need for granulocyte colony-stimulating factor (G-CSF) use were common with L/N. CONCLUSION: Findings suggest post-transplant L/N were common and associated with frequent modifications of immunosuppressive agents, requiring G-CSF use, and rejection or opportunistic infections. Findings highlight the need for interventions to reduce risk of L/N post-KT.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções Oportunistas / Transplante de Rim / Anemia / Leucopenia / Neutropenia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Limite: Adult / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções Oportunistas / Transplante de Rim / Anemia / Leucopenia / Neutropenia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Limite: Adult / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article