Department of Nephrology and Hypertension, Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa 216-8511, Japan.
Clin Exp Nephrol. 2010 Dec;14(6):637-40. doi: 10.1007/s10157-010-0323-y. Epub 2010 Aug 7.
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.
一位 27 岁女性接受其母亲活体肾脏移植。她接受了巴利昔单抗、他克莫司、霉酚酸酯（MMF）和皮质类固醇治疗。移植前，她的全血细胞计数和白细胞分类正常。术后约 70 天（POD70），她的白细胞（WBC）计数开始下降。POD113 时，她的 WBC 计数为 2800/μL。没有病毒感染、其他全身感染或恶性肿瘤的证据。怀疑药物诱导性中性粒细胞减少症，尤其是 MMF 诱导性中性粒细胞减少症，减少了 MMF 的剂量。然而，2 周内中性粒细胞计数降至 0/μL。我们进一步减少了 MMF 的剂量并给予了粒细胞集落刺激因子（G-CSF），这仅暂时增加了中性粒细胞计数。随后停用 MMF 并改用硫唑嘌呤，中性粒细胞计数恢复而没有随后发生排斥反应。MMF 诱导的中性粒细胞减少症经常发生，不仅应通过白细胞计数监测，还应通过白细胞分类计数监测，因为早期停药是成功解决中性粒细胞减少症的关键。从 MMF 转换为硫唑嘌呤或在不停止使用 MMF 的情况下使用 G-CSF 可能是避免随后发生排斥反应的治疗选择。
