Drug-Induced Leukopenia after Kidney Transplantation: Insights from Literature and a Clinical Case

Introduction: Leukopenia, particularly neutropenia, is a frequent hematological complication in kidney transplant recipients. It is most often related to immunosuppressive and prophylactic agents. These drugs are essential for preventing graft rejection and infection. However, they may induce myelosuppression. This leads to increased infection risk and often requires therapy modification. Materials and Methods: We conducted a narrative review of the literature by searching PubMed, Embase, and Scopus for studies published between January 2010 and June 2024. Search terms included “leukopenia,” “neutropenia,” “drug-induced,” “kidney transplantation,” “mycophenolate,” “valganciclovir,” “tacrolimus,” “cotrimoxazole,” and “myelosuppression.” Eligible studies involved adult kidney transplant recipients and reported drug-induced leukopenia. Results: Eight key studies were identified. Mycophenolate mofetil, valganciclovir, and trimethoprim-sulfamethoxazole were the most frequent causative agents. Tacrolimus was occasionally implicated. Reported incidence of leukopenia ranged from 19% to 83% during the first post-transplant year. Neutropenia occurred in up to 48% of patients. Risk factors included CMV D+/R− serostatus, combination therapy, and higher drug dosages. To illustrate clinical complexity, we present a case of a 36-year-old renal transplant recipient. He developed severe leukopenia and neutropenia two months post-transplant. White blood cell counts normalized following therapy adjustment and G-CSF administration, without subsequent rejection or infection. Conclusion: Drug-induced leukopenia is a common complication after kidney transplantation. It is seen particularly with mycophenolate and valganciclovir, and less often with tacrolimus. Early detection, individualized dose adjustment, and supportive therapies are essential. These measures balance infection prevention with adequate immunosuppression. Standardized management guidelines are lacking, highlighting the need for prospective studies.