Calcineurin Inhibitors and Neutropenia: Is Cyclosporine Superior to Tacrolimus?

Patient: Female, 51 Final Diagnosis: Tacrolimus induced severe neutropenia Symptoms: Abnormal lab values Medication: — Clinical Procedure: — Specialty: Transplantology OBJECTIVE: Adverse events of drug therapy BACKGROUND: Renal Transplant recipients are at risk for developing neutropenia from a multitude of causes. The cause is often multifactorial, and reversal of the most common causes/insults is sometimes insufficient. CASE REPORT: We present the case of a renal transplant recipient who developed a prolonged course of post-transplant (PTx) neutropenia that resolved after switching from tacrolimus (tac) to cyclosporine (CsA). CONCLUSIONS: Transplant recipients with persistent neutropenia, sometimes despite discontinuation of potential myelosuppressive agents like mycophenolic acid (MPA), valganciclovir, and sulfamethoxazole-trimethoprim (SMZ-TMP), and with introduction of granulocyte colony-stimulating factor (G-SF), and ruling out alternative diagnoses, may benefit from changing from tac to CsA.