PB0718 - Immune Thrombocytopenia treated with Avatrombopag in a Kidney Transplant Recipient

Background: Management of immune thrombocytopenia in a renal transplant recipient can be difficult given pre-existing immunosuppression and additional risks of infection. Treatment of these patients remains a challenge given lack of published data on safety, in particular potential deleterious effects on graft function.

Aims: We report on the first reported successful treatment of immune thrombocytopenia in this patient population with avatrombopag, a thrombopoietin receptor agonist.

Methods: The electronic medical record was retrospectively reviewed.

Results: A 65 year old year old man was reviewed with a sudden onset platelet count of 15 x 10^9/L. This was on a background of renal transplantation for which he remained significantly immunosuppressed with prednisone and tacrolimus. The sudden onset thrombocytopenia initially occurred in the setting of a severe COVID-19 infection with a superimposed bacterial/fungal pneumonia and CMV viraemia. A trial of IVIg resulted in a partial response though this was only transient. Given further significant risks of immunosuppression the patient was initially commenced on eltrombopag which did not result in a sustained response. Discussions were held with the patient regarding potential transition to romiplostim but given logistical difficulties with facilitating weekly administration a decision was made to trial avatrombopag therapy. Since commencement he has achieved a sustained response with a stable platelet count >50 x 10^9/L for the past 3 months. He has subsequently been re-commenced on his anticoagulation for atrial fibrillation and his renal graft function has remained stable.

Conclusion(s): This experience suggests that avatrombopag is safe and effective for immune thrombocytopenia in renal transplant recipients.