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Hematologic Complications of Transplantation

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Kidney Transplantation

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Abstract

Renal transplant recipients experience a wide variety of complications relating to the cell lines of the hematopoietic system and are among the primary limitations for the use of immunosuppressive therapies. Erythrocytosis, anemia, leukocytosis, leukopenia/neutropenia, and thrombocytopenia frequently occur after kidney transplantation from a variety of factors. Medications administered for immunosuppression and antimicrobial prophylaxis are principal causes of hematologic abnormalities. Therefore, the transplant pharmacist has a critical role in management. Posttransplant erythrocytosis may occur due to excessive erythropoietin production or inappropriate enhancement of the renin-angiotensin system from various causes. Postsurgical inflammation, infection, and use of corticosteroids can lead to leukocytosis. Viral infections common in the posttransplant period such as cytomegalovirus and parvovirus B19 cause leukopenia and anemia, respectively. Pancytopenia or reduced counts across cell lines are common with opportunistic infections like human herpes virus-6 (HHV-6), human herpes virus-8 (HHV-8), histoplasmosis, and blastomycosis. Some hematologic conditions are unique to transplant recipients and include thrombotic microangiopathy (TMA), hemophagocytic syndrome (HPS), and posttransplantation lymphoproliferative disorder (PTLD). In the setting of immunosuppression, there is an increased risk for posttransplant hematologic malignancies and solid tumors, and these may present as cytopenias.

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Authors and Affiliations

  1. Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, WI, USA

    Marissa M. Brokhof Pharm.D., B.C.P.S.

  2. University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI, 53792, USA

    David R. Hager Pharm.D., B.C.P.S., C.N.S.C.

  3. Division of Nephrology, University of Wisconsin, Madison, WI, USA

    Arjang Djamali M.D., M.S., F.A.S.N. & Vijay Vidyasagar M.D., M.P.H.

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  1. Marissa M. Brokhof Pharm.D., B.C.P.S.
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Correspondence to David R. Hager Pharm.D., B.C.P.S., C.N.S.C. .

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  1. Department of Nephrology, University of Maryland, Baltimore, Maryland, USA

    Matthew R. Weir

  2. Department of Medicine, Section of Nephrology, University of Illinois, Berwyn, Illinois, USA

    Edgar V. Lerma

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Brokhof, M.M., Hager, D.R., Djamali, A., Vidyasagar, V. (2014). Hematologic Complications of Transplantation. In: Weir, M., Lerma, E. (eds) Kidney Transplantation. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0342-9_22

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