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Granulocyte colony-stimulating factor usage in drug-induced neutropenia after kidney transplantation: a single-center experience

Introduction. Granulocyte colony-stimulating factor (G-CSF) therapy is commonly used in kidney and liver transplant recipients with severe neutropenia. However, rapid and high increases in neutrophil counts of some patients may occur during treatment. This retrospective study aimed to determine the efficacy and safety of G-CSF treatment in neutropenic kidney transplant recipients. Methods. Eight kidney transplant recipients treated with G-CSF for drug-induced neutropenia (neutrophil count <1000 cells/µL) were included in the study. Daily renal function tests, leukocyte (WBC) and absolute neutrophil counts were measured. Results. The median duration of G-CSF treatment was 4 days (2-5). The median WBC and neutrophil counts elevated from 1130 and 565 cells/μL to 4400 and 1950 cells/μL after treatment, respectively (p=0.012). The median peak WBC and neutrophil counts during treatment were 18,045 and 16,445 cells/μL, respectively. The WBC counts returned to normal limits after a median of 22 days from the maximum value. No acute rejection was observed within three months of discontinuation of treatment. Conclusions. G-CSF may be a useful therapeutic alternative for kidney recipients with severe neutropenia. It seems reasonable to withdraw G-CSF treatment when WBC and neutrophil counts reach certain cut-off values during treatment.