Cytomegalovirus Infection Associated Neutropenia and Acute Kidney Graft RejectionZ Veceric-Haler1*, D Kovac1, J Tomazic2 and J Lindic1
- *Corresponding Author:
- Zeljka Veceric-Haler
Department of Nephrology
University Medical Centre Ljubljana, Slovenia
Tel: +00 385 31 580 325
E-mail: [email protected]
Received Date: May 10, 2017; Accepted Date: May 25, 2017; Published Date: May 31, 2017
Citation: Veceric-Haler Z, Kovac D, Tomažic J, Lindic J (2017) Cytomegalovirus Infection Associated Neutropenia and Acute Kidney Graft Rejection. J Nephrol Ther 7: 293. doi:10.4172/2161-0959.1000293
Copyright: © 2017 Veceric-Haler Z, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Cytomegalovirus (CMV) infection, neutropenia occurrence and mycophenolate (MMF) dose reduction are associated with an increased risk of acute kidney graft rejection. The aim of our retrospective clinical study was to evaluate the association of CMV associated neutropenia with a consequent MMF dose reduction and acute kidney graft rejection. Method: 161 patients transplanted from January 2005 till December 2010, who received anti-CD25 antibodies induction, MMF, calcineurin inhibitor and steroids, were retrospectively analyzed for the incidence of neutropenia (leucocyte count <4.0 x 106/mL with reduced rate of neutrophils to <1.6 x 106/mL in differential white blood cell count, CMV viremia (>150 virus copies/mL detected by polymerase chain reaction), MMF dose modification, granulocyte colony-stimulating factor (G-CSF) therapy and rejection episodes. Results: Neutropenia was detected in 41 (25.5%) patients. It was associated with CMV viremia (p<0.001) but not with CMV prophylactic therapy. MMF dose was reduced due to neutropenia in 29 patients (70.7%) and acute rejection occurred in 6 (14.6%) of them. The average reduction of MMF dose in these patients was 31% of the initial dose. All neutropenic patients with rejection had concomitant CMV infection. There was a trend to positive correlation between MMF reduction and CMV infection or rejection (p=0.06). G-CSF was used in 16 (39.02%) neutropenic patients. No significant correlation was found between G-CSF use and occurrence of acute rejection. Conclusion: CMV infection was important cause of neutropenia that resulted in MMF dose reduction and increased rate of acute graft rejection. G-CSF therapy is an alternative therapeutic approach in neutropenic patients that enables the maintenance of optimal therapeutic dose of MMF and without significant influence on acute rejection occurrence.