Hematologic abnormalities in children and young adults receiving tacrolimus-based immunosuppression following cardiothoracic transplantation

To define the incidence, course, and etiology of hematologic abnormalities in children on lacrolimus-based immunosuppression, we reviewed records of 1 06 transplant patients (70 heart, 16 heart and lung, 20 double lung), 0-21 yr of age, who were transplanted at the Children's Hospital of Pittsburgh f rom 1989 to 1997. Fifty-four of the 106 patients (51%) developed 65 abnorma l hematologic episodes (32 anemia, nine neutropenia, nine thrombocytopenia, 15 simultaneous anemia and neutropenia with ol without thrombocytpenia). C ommon etiologies included: infections, post-transplant lymphoproliferative disease, and medications. Eleven episodes (seven anemia, one neutropenia, a nd three simultaneous anemia and neutropenia) had unclear etiologies and pr ocess of elimination suggested an association with tacrolimus. Intervention s included filgrastim (effective in 15 of 15 patients, with resolution of n eutropenia in a median of 5 days) and epoetin alfa (effective in five of 16 patients, including four of four patients with anemia possibly related to tacrolimus). Five patients (two with neutropenia and three with simultaneou s neutropenia and anemia) were switched to cyclosporin A (CsA); rapid resol ution occured in four of the five patients, suggesting a possible associati on of the hematologic abnormalities with tacrolimus. In summary, hematologi c abnormalities are common in children on tacrolimus-based immunosuppressio n. Most of these hematologic abnormalities are caused by common etiologies; however, a sub-population exists where tacrolimus may be the etiologic age nt. Anemia and neutropenia respond to treatment with epoetin alfa and filgr astim. After thorough investigation, a trial switch to CsA may be warranted .