Single‐center, real‐world experience with granulocyte colony‐stimulating factor for management of leukopenia following kidney transplantation

Background Leukopenia is a frequent complication following kidney transplantation. Granulocyte colony‐stimulating factor (G‐CSF) has been used to accelerate white blood cell (WBC) count recovery; however, published experience in kidney transplantation is limited. Methods We retrospectively reviewed our kidney transplant recipients from January 2012 to September 2016 with a G‐CSF order to evaluate leukopenia management (defined as WBC <3000 cells/μL). Results Thirty‐six recipients were included. On average, G‐CSF treatment began at 98 ± 38 days. At G‐CSF initiation, mean WBC count was 1240 ± 420 cells/μL and absolute neutrophil count (ANC) was 653 ± 368 cells/μL. Mean G‐CSF dose was 4.6 ± 1.2 mcg/kg/dose (total 11.8 ± 9.0 mcg/kg), 77.8% of recipients were prescribed G‐CSF as outpatients, and overall, median time to WBC count recovery was 9 (IQR 4‐14) days. Changes in immunosuppression and prophylaxis regimens for leukopenia were also common. Within 1 month following leukopenia onset, no patients experienced acute rejection and 5 (14%) developed infection requiring hospitalization or opportunistic infection. Conclusion In kidney recipients with leukopenia, G‐CSF may be helpful to achieve WBC count recovery in addition to changes in immunosuppression and prophylaxis medications. Prospective, randomized data are still needed to determine optimal G‐CSF dosing in this population.