Review Article

Drug-Induced Hematological Cytopenia in Kidney Transplantation and the Challenges It Poses for Kidney Transplant Physicians

Table 2

Showing various studies done colony-stimulating factors.

Granulocyte Colony-Stimulating Factor (G-CSF)

AuthorJournal/YearStudyFinding

Schmaldienst S et al.[244]Transplantation / 2000Author compared 30 episodes of leucopenia treated with G-CSF and compared them with age and sex matched historical control group in kidney transplant recipients.Leukopenic episodes in treated groups were shorter, infections were significantly less and no evidence for triggering a rejection was found.

Peddi VR et al.[245]Clin transplant / 1996Retrospective analysis of 25 episodes of neutropenia in kidney or combined kidney and pancreas transplant who received G-CSFAuthors found G-CSF effective in reversing neutropenia and no evidence of rejection was found.

Turgeon N et al.[246]Transpl Infect Dis/2000Retrospective analysis of 50 patients (both kidney and liver transplant) who received 100 doses of G-CSFIt reversed neutropenia, allowed maximum doses of ganciclovir to treat CMV and was well tolerated. No relation was found between the highest WBC obtained during G-CSF therapy and the risk of rejection

Gordon MS et al.[250]J Heart Lung Transplant / 1993Febrile neutropenia in a heart transplant due to immunosuppressive medicationsNeutrophil counts improved. Infection was successfully treated. Endomyocardial biopsy showed no rejection.

Ishizone S et al.[251]J Pediatr Surg /19943 patients with severe liver disease and hypersplenism received G-CSFG-CSF improved white cell counts without adverse events.

Foster PF et al.[252]Transplantation / 1995Prospective analysis of 37 primary liver allograft recipients received G-CSF for first 7 to 10 days.Significant increase in white cell count, reduced rate of sepsis and sepsis related death were found in G-CSF group. The incidence of acute rejection was decreased in the G-CSF-treated group (22% vs. 51%, P < 0.01, chi-square test).

Winston DJ et al.[253]Transplantation/1999Randomized, placebo-controlled, double-blind, multicenter trial of efficacy and safety of granulocyte colony-stimulating factor in liver transplant recipients.There was increase in white cell count. However there was no beneficial effect of G-CSF on infection, rejection and survival when compared to placebo.

Granulocyte Monocyte-Colony Stimulating Factor (GM-CSF)

Hashmi A et al.[258]Transplant Proc / 19977 patients with neutropenia were given GM-CSF and were compared with historical 7 control having neutropenia but have not received any GM-CSFMean leukocyte count was more in treated group. Infection, mean hospital stay and mortality was less in those who were treated with GM-CSF

Trindade E et al.[259]Transplant Proc / 199713 children received 15 courses of GM-CSFWhite cell count increased in all except one. No episode of rejection occurred. GM-CSF was found. It was beneficial in patients with severe bacterial infections.

Kutsogiannis DJ.[261]Transplantation / 1992Granulocyte macrophage colony-stimulating factor was used for the therapy of cytomegalovirus and ganciclovir-induced leucopenia in a renal transplant recipient.It was helpful for improving white cell count and using adequate doses of anti CMV medications

Page AV. Et al.[262]Curr Opin Organ Transplant /2008Review articleAlthough there are encouraging results of G-CSF, GM-CSF and other immunomodulatory therapies in in vitro and in preclinical models still they have not met desired effects in solid organ transplantation and further studies are needed.