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Master Thesis

Impact of immunosuppressive strategies on post kidney transplantation thrombocytopenia

Abstract : Introduction: Thrombocytopenia after kidney transplantation is a common complication partly induced by immunosuppressive therapies. It might be responsible for serious hemorrhages and compromise graft and patient survival. We assessed the incidence of post transplantation thrombocytopenia in four immunosuppressive regimens as well as post transplantation safety and efficacy. Methods: In this observational single-center retrospective study, we included all recipients who received rabbit antithymocyte globulin induction, either Thymoglobulin® (THY) or Grafalon® (GRA), and maintenance therapy which consisted in either Mycophenolate Mofetil (MMF) or Everolimus (EVR), associated with Tacrolimus and corticosteroids. Thrombocytopenia was defined as platelet count of less that 150 000 per cubic millimeter. Results: Between 27th of July 2016 and 7th of September 2018, 237 recipients were included and 64.6% of them experienced thrombocytopenia within the first week. Thrombocytopenia was significantly more frequent (p=0.004) among GRA-treated patients (73.4%) compared to THY-treated patients (61.3%). These patients also had lower nadir platelet count (120G/l vs. 142G/l; p=0.002) and lower platelet count at discharge (227G/l vs. 243G/l; p=0.249). The GRA-EVR group had worse rate of thrombocytopenia (81.0% vs. 61.4%, 60.9% and 69.8% in THY-MMF, THY-EVR and GRA-MMF groups; p=0.081) and worse nadir platelet count (109G/l vs. 141G/l, 145G/l and 125G/l; p=0.011) but GRA was the only risk factor of thrombocytopenia in multivariate analyses (p=0.002). Rates of hemorrhages, red blood cell transfusions and reoperation within the first week as well as rates of delayed graft function, acute rejection, graft loss and death did not differ between groups after a mean time of follow-up of 25 +/- 8months. Conclusion: It is of clinical interest that GRA associated with EVR led to more frequent and severe thrombocytopenia although there was no significant clinical consequence in this study.
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Valentine Gierczak. Impact of immunosuppressive strategies on post kidney transplantation thrombocytopenia. Human health and pathology. 2020. ⟨dumas-02563099⟩

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