Effect of Age on Leukopenia Following Renal Transplantation at a Single Center.

INTRODUCTION: Leukopenia in renal transplant recipients occurs commonly within the first year following transplantation; however, literature on the effects of age on leukopenia is scarce. DESIGN: A single-center, retrospective review was conducted on 141 recipients transplanted from January 2011 to December 2015. Transplant recipients were characterized by age <60 years (n = 94) or age 60 years and older (n = 47) for analysis. RESULTS: A greater incidence of leukopenia was seen in the older cohort compared to the younger cohort (64% vs 55%). Of those patients who developed leukopenia, the older cohort (n = 30) had a higher incidence of hospitalization for leukopenia (30% vs 23%) but a lower incidence of hospitalization for infection (20% vs 25%) compared to the younger cohort (n = 52). Additionally, one month following mycophenolate mofetil (MMF) discontinuation, the older cohort had reduced recovery of their white blood cell count (+263.8% vs +272.5%) and experienced less recurrent leukopenic episodes (50% vs 67%) and rejection episodes (0% vs 22%) compared to the younger cohort, alluding to the need for less immunosuppression. CONCLUSIONS: Age at transplantation was not associated with the development of leukopenia; however, older patients had a higher incidence of leukopenia and hospitalization for leukopenia. Dose reduction or discontinuation of MMF should be considered in older kidney transplant recipients who develop leukopenia.

Risky Business: Judging the Use of Non-Vitamin K Antagonist Oral Anticoagulants for Non-Valvular Atrial Fibrillation in Patients with Renal Dysfunction.

Warfarin, for many years, was the only oral anticoagulant availablt on the market for the prevention of stroke in patients with atrial fibrillation. Despite being safe and effective, warfarin's medication and food interactions, along with its requirement for frequent monitoring, make it ltss ideal in some patient populations. More recently, non-vitamin K oral antagonists (NOACs) have emergtd as an appealing option as they have fewer medication interactions, do not have food interactions and do not require frequent monitoring. However, patients with a creatinine cltarance (CrCl) of ltss than 30 mL/min were excluded in original drug trials for these agtnts. ltaving providers without certainty that these agtnts can be used safely and effectively in patients with renal dysfunction. This review article will summarize the current availablt data on the use of NOACs for the prevention of stroke in atrial fibrillation patients with renal dysfunction.

Evaluation of Filgrastim Therapy in Kidney Transplant Recipients.

CONTEXT: Neutropenia is associated with a high risk of serious infections in kidney transplant recipients. There are no sufficient studies of using granulocyte colony-stimulating factors, such as filgrastim, in renal transplant recipients to establish a clear, specified role of this off-label indication. Using filgrastim in these patients may increase the risk of rejection by overstimulating the immune system. OBJECTIVE: To evaluate the use of filgrastim in adult kidney transplant recipients presenting with neutropenia. PATIENTS AND DESIGN: Data were obtained from a medication utilization report of filgrastim in kidney transplant recipients at our center from September 2012 to August 2015. Main Outcome Measure(s) and Results: There were 28 cases of neutropenia that were treated with a range of 1 to 5 doses of filgrastim 300 or 480 µg, with a mean of 1.79 doses. The mean total dose of filgrastim administered per episode of neutropenia was 632 µg (8.6 µg/kg). Overall, 87.5% of the cases achieved a white blood cell count of at least 3 × 109 cells/L within 7 days of hospital discharge. There were no cases of infection or acute rejection following treatment. CONCLUSIONS: The use of filgrastim in kidney transplant recipients demonstrated success in reversing neutropenia. Short courses of therapy were required with minimal adverse events. Patients who required readmission were successfully re-treated. Additional studies are required to determine the most effective dose and duration of treatment.

Duration of prophylaxis against fungal infection in kidney transplant recipients.

OBJECTIVE: To compare the efficacy of 2 strategies that use nystatin to prevent thrush and Candida esophagitis in kidney transplant recipients. METHODS: A retrospective chart review was conducted of adult kidney transplant recipients at our center, where the protocol for prophylaxis against fungal infection was changed in March 2013. Before the protocol change, kidney transplant recipients received nystatin for 1 month (before group) and after the change they received nystatin for the duration of admission (after group). The primary outcome measure was the incidence of thrush and Candida esophagitis within 3 months after transplant. Analyses were conducted on all kidney transplant recipients (intention to treat) and on only those kidney transplant recipients who received at least 1 dose of nystatin (modified intention to treat). Additional data collected included the duration of nystatin and immunosuppression regimens. The Student t test and Fisher exact test were used to calculate P values for continuous and categorical data. RESULTS: A total of 84 kidney transplant recipients, 42 in each cohort, were included in the analysis. The groups did not differ significantly at baseline. Nystatin was administered for a mean of 29 days in the before group and 5.74 days in the after group. Overall, 3 kidney transplant recipients (4%), all from the after group, experienced an episode of thrush and no patients experienced Candida esophagitis. Two recipients who experienced thrush did not receive any nystatin. CONCLUSIONS: Limiting the administration of nystatin to the duration of admission after transplant may be sufficient for prophylaxis of fungal infections in kidney transplant recipients.

A simulated hospital pharmacy module using an electronic medical record in a pharmaceutical care skills laboratory course.

OBJECTIVES. To implement and evaluate the effects of a simulated hospital pharmacy module using an electronic medical record on student confidence and abilities to perform hospital pharmacist duties. DESIGN. A module was developed that simulated typical hospital pharmacist tasks. Learning activities were modified based upon student feedback and instructor assessment. ASSESSMENTS. Ninety-seven percent of respondents reported full-time hospital internship experience and 72% had electronic medical record experience prior to completing the module. Mean scores on confidence with performing typical hospital pharmacist tasks significantly increased from the pre-module survey to the post-module survey from 1.5-2.9 (low comfort/confidence) to 2.0-3.4 (moderate comfort/confidence). Course assessments confirmed student achievement of covered competencies. CONCLUSIONS. A simulated hospital pharmacy module improved pharmacy students' hospital practice skills and their perceived comfort and confidence in completing the typical duties of a hospital pharmacist.