Incidence Of Post-transplant Erythrocytosis Research Articles

Post-Transplant Erythrocytosis in Live Donor Kidney Transplant Recipients: A Retrospective Single Center Study

Introduction: Post-transplant erythrocytosis (PTE) is defined as persistently elevated hemoglobin>17 g/dl and/or PCV>51% in kidney transplant recipients. The incidence of PTE varies from 5% to 17%, with occasional life-threatening thromboembolic complications. We aimed to study the prevalence, risk factors and complications of PTE. Methods: We conducted a retrospective single center study in 132 kidney transplant recipients who had undergone live donor kidney transplantation at Tribhuvan University Teaching Hospital, Nepal, between October 2017 and March 2019. Prior approval was obtained from Institutional Review Committee of Institute of Medicine. Patients with hemoglobin>17 g/dl were defined as PTE group, and others as non-PTE group. The pattern of hemoglobin, serum creatinine, pre-transplant hemoglobin, native kidney disease, immunosuppression medications, rejection episodes, and new onset diabetes after transplantation were analyzed and compared between two groups. Results: Out of the 132 kidney transplant recipients, PTE was diagnosed in 28 (21.2%) patients, out of which 27 patients (96.4%) were male and 1 (3.6%) were female with the mean time of onset at 7 months after transplantation. Patients with erythrocytosis had a relatively shorter duration of pre transplant dialysis (p=0.001). The mean pre transplant Hb and Hct in PTE group was 9.72g/dl and 30.35% whereas in non PTE group 10.02 g/dl and 31.31%. Thromboembolic and any other PTE related complications were not observed. Seventeen patients of PTE (60.7%) were treated with ACE Inhibitors and 11 (39.9%) patients did not require any treatment. Conclusion: Post-transplant erythrocytosis was seen in nearly one fifth kidney transplant recipients at mean time of seven months post-transplantation; was more common in male with good graft function, and short duration of pre transplant dialysis. Response to ACE inhibitors was good.

Post-Transplant Erythrocytosis in Live Donor Kidney Transplant Recipients: A Retrospective Single Center Study

Introduction Post-transplant erythrocytosis (PTE) is defined as persistently elevated hemoglobin>17 g/dl and/or PCV>51% in kidney transplant recipients. The incidence of PTE varies from 5% to 17%, with occasional life‑threatening thromboembolic complications. We aimed to study the prevalence, risk factors and complications of PTE.
 MethodsWe conducted a retrospective single center study in 132 kidney transplant recipients who had undergone live donor kidney transplantation at Tribhuvan University Teaching Hospital, Nepal, between October 2017 and March 2019. Prior approval was obtained from Institutional Review Committee of Institute of Medicine. Patients with hemoglobin>17 g/dl were defined as PTE group, and others as non‑PTE group. The pattern of hemoglobin, serum creatinine, pre-transplant hemoglobin, native kidney disease, immunosuppression medications, rejection episodes, and new onset diabetes after transplantation were analyzed and compared between two groups.
 ResultsOut of the 132 kidney transplant recipients, PTE was diagnosed in 28 (21.2%) patients, out of which 27 patients (96.4%) were male and 1 (3.6%) were female with the mean time of onset at 7 months after transplantation. Patients with erythrocytosis had a relatively shorter duration of pre transplant dialysis (p=0.001). The mean pre transplant Hb and Hct in PTE group was 9.72g/dl and 30.35% whereas in non PTE group 10.02 g/dl and 31.31%. Thromboembolic and any other PTE related complications were not observed. Seventeen patients of PTE (60.7%) were treated with ACE Inhibitors and 11 (39.9%) patients did not require any treatment.
 ConclusionPost-transplant erythrocytosis was seen in nearly one fifth kidney transplant recipients at mean time of seven months post-transplantation; was more common in male with good graft function, and short duration of pre transplant dialysis. Response to ACE inhibitors was good.

Incidence, risk factors, and outcomes of post‐transplant erythrocytosis after kidney transplantation

The incidence, risk factors, and outcomes of kidney transplant recipients (KTRs) with post-transplant erythrocytosis (PTE) in the modern era of strong, protocolized immunosuppressive management are unknown. In this study, we aim to identify the incidence and risk factors of PTE and outcomes associated with PTE. This study examined adult KTRs transplanted at our hospital between 01/2001 and 12/2016. Controls were KTRs without PTE and selected in a 1:5 ratio using incident density sampling. Patient survival, graft survival, and vascular thromboembolism (VTE) incidence were outcomes of interest. Of 4,317 kidney transplants during the study period, 214 (5%) had PTE and were compared with controls. In the multivariate analysis, recipients with older age (HR: 0.97, 95% CI 0.96-0.99, p=.001) were less likely to develop PTE, while male gender (HR: 3.2; 95% CI: 1.92-5.3, p<.001) and non-preemptive transplant (HR: 3.86, 95% CI 1.56-9.56, p=.003) were associated with increased risk of PTE. After adjustment for confounding factors, PTE was not associated with patient mortality (HR: 0.99, 95% CI 0.69-1.42, p=.97), graft failure (HR: 1.11, 95% CI 0.68-1.80, p=.69), or VTE (HR: 1.07, 95% CI 0.59-1.96, p=.81). The incidence of PTE is still substantial in this era, but with proper management PTE does not impact patient or graft survival.

Post renal transplant polycythemia and treatment: A single center study.

To calculate the incidence of post-transplant erythrocytosis, and to assess the response to treatment. The prospective study was conducted from April 2016 to April 2018 at the Department of Nephrology, Bahria International Hospital, Lahore, Pakistan, and comprised patients undergoing renal transplantation who were evaluated and followed up for 12 months. Patients having haemoglobin levels ≥17gm/dl were labelled as having polycythemia. Data was analysed using SPSS 21. Of the 94 total patients, 69(73.4%) were enrolled. During follow-up, 2(2.9%) of them died, and, thus, the final sample stood at 67(71.3%); 57 (85%) males and 10(15%) females. The mean age of the sample was 32.6±8.8 years. Overall, 19(28.4%) patients developed polycythemia and they were either given angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Of these 19 patients, 11(57.8 %) responded to the treatment, while 8(42.1%) required phlebotomy. Further, 3(15.7%) patients required one phlebotomy, while 5(26.3%) who had glomerular filtration rate >30% had to have repeated phlebotomy. The incidence of post-transplant erythrocytosis was significantly high at 28.4%.

Erythrocytosis in renal transplant recipients: A single-center experience

Background: Posttransplant erythrocytosis (PTE) is defined as persistently elevated hemoglobin (Hb) >17 g/dl and or PCV >51% in renal transplant recipients. The incidence of PTE varies from 8% to 22%, with occasional life-threating thromboembolic complications. Our aim was to study the prevalence, risk factors, course, and complications of PTE. Materials and Methods: We conducted a cross-sectional descriptive study in 327 renal transplant recipients. Patients with Hb >17 g/dl were considered as PTE group, and others were considered as non-PTE group. The pattern of Hb, serum creatinine, mean arterial pressure (MAP) change, and requirement of anti-hypertensive medications was noted. Complications and their management were noted. Results: PTE was diagnosed in 51 (15.5%) patients with the median time of onset at 8 (95% confidence interval: 6–10) months after transplantation. During PTE, the mean highest documented Hb was 18.68 ± 0.73 g/dl. Mean Hb change had significant positive (r = 0.8493; P = 0.0156) correlation with mean MAP change. The dose of antihypertensive medications was increased more within 6 months of PTE diagnosis and decreased thereafter significantly. Thrombotic complications were observed in 5 (10.6%) patients. PTE was treated with enalapril in 35 (72.5%) patients and combination with phlebotomy in 11 (21.6%). Around 30 (58.8%) patients continued enalapril therapy to maintain the Hb. Conclusion: PTE was observed in 15.5% of renal allograft recipients. Hb change was temporally related to blood pressure in PTE patients. Both erythrocytosis and hypertension responded well to angiotensin-converting enzyme inhibitor.

Elevated Incidence of Posttransplant Erythrocytosis After Simultaneous Pancreas Kidney Transplantation

Posttransplant erythrocytosis (PTE) poses a potential risk of thrombosis in kidney transplantation. Clinical observation of our systemically drained simultaneous kidney pancreas transplant (S-SPK) patients showed a higher incidence of PTE and need for phlebotomies. To evaluate the incidence of PTE we analyzed hematocrit (Hct) levels and frequency of phlebotomies in 94 SPK as compared to 174 living donor (LD) recipients and 53 type-I diabetic with kidney transplant only. For study purposes we defined PTE as Hct >50% or the necessity for phlebotomies. Kaplan-Meier plots and Cox proportional hazard models were used to examine the association between the transplant type and PTE. We found an increased incidence of PTE in SPK compared to LD (p < 0.001). In the multivariate model, SPK had a 5-fold risk for the development of PTE (AHR 5.3, 95% CI 1.8, 15.9). The incidence of therapeutic phlebotomy was 13% among SPK patients and 4% in LD kidney recipients; 19 patients altogether. A total of 64 units were phlebotomized (48-SPK and 16-LD). Type I diabetic patients with a kidney transplant showed a 0% incidence of PTE. We observed a greater incidence of PTE and phlebotomies in S-SPK compared to LD with kidney only transplant recipients.

Postrenal transplant erythrocytosis: A review of 53 patients

Review of a large renal transplant experience revealed a 17.3% incidence of posttransplant erythrocytosis. The influence of kidney source, pretransplant hematocrit, duration of pretransplant dialysis, renal transplant function, acute rejection, transplant renal artery stenosis, urinary tract obstruction, smoking, diabetes, retention of native kidneys, splenectomy, parathyroidectomy, immunosuppression, hypertension, and liver enzyme abnormalities on the development of erythrocytosis in 53 recipients was determined. Comparison was made with 49 control recipients matched for kidney function, time after grafting, age, and sex. Erythrocytosis occurred 3 to 90 months after transplantation and persisted for 1 to over 84 months. Risk factors for the development of erythrocytosis were smoking, diabetes, and a rejection free course. In contradistinction to previous smaller series, erythrocytosis occurred in patients with good renal function (serum creatinine 1.62 +/- 0.43 mg/dl) without prominence of graft rejection, transplant artery stenosis or obstruction. Despite therapeutic phlebotomy, 11 thromboembolic events occurred in 10 of the 53 patients with erythrocytosis, but in none of the controls (P less than 0.001). The high incidence of erythrocytosis following renal transplantation and the risk of associated thromboembolic events should encourage awareness and controlled evaluation of therapeutic modalities.