Leukopenia in Kidney Transplant Patients With the Association of Valganciclovir and Mycophenolate Mofetil

Abstract Cytomegalovirus (CMV) is the most common viral infection after transplantation. Valganciclovir (VGC) is established for prophylaxis and treatment of CMV infections, but leukopenia which appears in 10% to 13% (severe in 4.9%) is the principal side effect. We have recently noted an increased incidence of leukopenia and severe neutropenia among our renal transplant patients and thought to identify the associated factors. We conducted a retrospective analysis of all kidney transplantations performed between January 2005 and December 2006. All patients received mycophenolate mofetil (MMF), tacrolimus, and steroids. VGC was used for targeted prophylaxis and preemptive therapy of CMV infection, with doses adjusted to renal function. Of the 64 patients undergoing renal transplantation 13 (20.3%) developed leukopenia within 3 ± 2 months after transplantation with severe neutropenia in 5 (7.8%). All patients were on MMF and VGC (VGC 605 ± 296 mg/d). Leukopenia was significantly associated with simultaneous liver–kidney transplantation and with second kidney transplantations ( P P = .008) with maximal incidence observed among patients prescribed 900 mg/d as opposed to those on lower doses ( P