Clinical and Experimental Nephrology

, Volume 14, Issue 6, pp 637–640 | Cite as

Mycophenolate mofetil-induced agranulocytosis in a renal transplant recipient

  • Katsuomi Matsui
  • Yugo Shibagaki
  • Hideo Sasaki
  • Tatsuya Chikaraishi
  • Takashi Yasuda
  • Kenjiro Kimura
Case Report

Abstract

A 27-year-old woman underwent living kidney transplantation from her mother. She received basiliximab, tacrolimus, mycophenolate mofetil (MMF), and a corticosteroid. Before transplantation, her complete blood count and white cell differential were normal. On about the 70th postoperative day (POD 70), her white blood cell (WBC) count began to decrease. On POD 113, her WBC count was 2800/μL. There was no evidence of viral infection, other systemic infection or malignancy. Drug-induced neutropenia, especially MMF-induced neutropenia, was suspected, and the dosage of MMF was reduced. However, the neutrophil count fell to 0/μL within 2 weeks. We further reduced the dosage of MMF and administered granulocyte-colony stimulating factor (G-CSF), which only temporarily increased the neutrophil count. Then, MMF was discontinued and switched to azathioprine, resulting in recovery of neutrophil count without subsequent rejection. MMF-induced neutropenia frequently occurs and should be monitored not only by WBC count but also by white cell differential count, since early discontinuation is the key to successful resolution of neutropenia. Switching from MMF to azathioprine or administration of G-CSF with or without MMF discontinuation might be options for treatment to avoid subsequent rejection.

Keywords

Agranulocytosis Leukopenia Mycophenolate mofetil Neutropenia 

References

  1. 1.
    Allison AC, Eugui EM. Purine metabolism and immunosuppressive effects of mycophenolate mofetil (MMF). Clin Transpl. 1996;10:77.Google Scholar
  2. 2.
    Brennan DC, Daller JA, Lake KD, Cibrik D, Del Castillo D. Thymoglobulin Induction Study Group. Rabbit antithymocyte globulin versus basiliximab in renal transplantation. N Engl J Med. 2006;355:1967.CrossRefPubMedGoogle Scholar
  3. 3.
    Brum S, Nolasco F, Sousa J, Ferreira A, Possante M, Pinto JR, et al. Leukopenia in kidney transplant patients with the association of valganciclovir and mycophenolate mofetil. Transpl Proc. 2008;40:752.CrossRefGoogle Scholar
  4. 4.
    Rerolle JP, Szelag JC, Le Meur Y. Unexpected rate of severe leucopenia with the association of mycophenolate mofetil and valganciclovir in kidney transplant recipients. Nephrol Dial Transpl. 2007;22:671.CrossRefGoogle Scholar
  5. 5.
    Chen IM, Chang HH, Hsu CP, Lai ST, Hsieh YC, Shih CC. Correlation between body mass index and leucopenia after administration of valganciclovir for cytomegalovirus infection in Chinese cardiac recipients. Circ J. 2007;71:968.CrossRefPubMedGoogle Scholar
  6. 6.
    Zafrani L, Truffaut L, Kreis H, Etienne D, Rafat C, Lechaton S, et al. Incidence, risk factors and clinical consequences of neutropenia following kidney transplantation: a retrospective study. Am J Transpl. 2009;9:1816.CrossRefGoogle Scholar
  7. 7.
    Mourad M, Malaise J, Chaib Eddour D, De Meyer M, Konig J, Schepers R, et al. Correlation of mycophenolic acid pharmacokinetic parameters with side effects in kidney transplant patients treated with mycophenolate mofetil. Clin Chem. 2001;47:88.PubMedGoogle Scholar
  8. 8.
    Banerjee R, Halil O, Bain BJ, Cummins D, Banner NR. Neutrophil dysplasia caused by mycophenolate mofetil. Transplantation. 2000;70:1608.CrossRefPubMedGoogle Scholar
  9. 9.
    Cattaneo D, Perico N, Gaspari F, Gotti E, Remuzzi G. Glucocorticoids interfere with mycophenolate mofetil bioavailability in kidney transplantation. Kidney Int. 2002;62:1060.CrossRefPubMedGoogle Scholar
  10. 10.
    Johnson HJ, Swan SK, Heim-Duthoy KL, Nicholls AJ, Tsina I, Tarnowski T. The pharmacokinetics of a single oral dose of mycophenolate mofetil in patients with varying degrees of renal function. Clin Pharmacol Ther. 1998;63:512.CrossRefPubMedGoogle Scholar
  11. 11.
    Nogueras F, Espinosa MD, Mansilla A, Torres JT, Cabrera MA, Martin-Vivaldi R. Mycophenolate mofetil-induced neutropenia in liver transplantation. Transpl Proc. 2005;37:1509.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2010

Authors and Affiliations

  • Katsuomi Matsui
    • 1
  • Yugo Shibagaki
    • 1
  • Hideo Sasaki
    • 2
  • Tatsuya Chikaraishi
    • 2
  • Takashi Yasuda
    • 1
  • Kenjiro Kimura
    • 1
  1. 1.Department of Nephrology and Hypertension, Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
  2. 2.Department of UrologySt. Marianna University School of MedicineKawasakiJapan

Personalised recommendations