Contemporary incidence and risk factors of post transplant Erythrocytosis in deceased donor kidney transplantation

Abstract

Background Post-Transplant erythrocytosis (PTE) has not been studied in large recent cohorts. In this study, we evaluated the incidence, risk factors, and outcome of PTE with current transplant practices using the present World Health Organization criteria to define erythrocytosis. We also tested the hypothesis that the risk of PTE is greater with higher-quality kidneys. Methods We utilized the Deceased Donor Study which is an ongoing, multicenter, observational study of deceased donors and their kidney recipients that were transplanted between 2010 and 2013 across 13 centers. Eryrthocytosis is defined by hemoglobin> 16.5 g/dL in men and> 16 g/dL in women. Kidney quality is measured by Kidney Donor Profile Index (KDPI). Results Of the 1123 recipients qualified to be in this study, PTE was observed at a median of 18 months in 75 (6.6%) recipients. Compared to recipients without PTE, those with PTE were younger [mean 48±11 vs 54±13 years, p < 0.001], more likely to have polycystic kidney disease [17% vs 6%, p < 0.001], have received kidneys from younger donors [36 ±13 vs 41±15 years], and be on RAAS inhibitors [35% vs 22%, p < 0.001]. Recipients with PTE were less likely to have received kidneys from donors with hypertension [16% vs 32%, p = 0.004], diabetes [1% vs 11%, p = 0.008], and cerebrovascular event (24% vs 36%, p = 0.036). Higher KDPI was associated with decreased PTE risk [HR 0.98 (95% CI: 0.97–0.99)]. Over 60 months of follow-up, only 17 (36%) recipients had sustained PTE. There was no association between PTE and graft failure or mortality, Conclusions The incidence of PTE was low in our study and PTE resolved in majority of patients. Lower KDPI increases risk of PTE. The underutilization of RAAS inhibitors in PTE patients raises the possibility of under-recognition of this phenomenon and should be explored in future studies.

Post‐transplantation erythrocytosis in kidney transplant recipients—A retrospective cohort study

“…14,28 Regarding the prognosis of PTE patients, we found no difference in graft loss in the PTE group compared with the control group in both univariate and multivariate analyses, which is in accordance with other studies results. 2,3,5,31,32 There was no difference in the frequency of cardiovascular events in PTE compared with non-PTE patients. In contrast, some studies displayed a worrisome association between PTE and graft failure.…”

“…In a study by Alzoubi et al, the frequency of PTE was only 5% )214 of 4317 patients) 31 and in a study by Alsafar et al, the frequency was 6.6% (75 of 1123). 32 This was probably attributed to the wider use of ACEI and immunosuppressive drugs. However, as in our study, other publications during the last decade still present a variable prevalence of PTE ranging from 9.5% 30 to 20%.…”

Risk factors and outcomes of post‐transplant erythrocytosis among adult kidney transplant recipients: a systematic review and meta‐analysis

“…A total of 61 studies underwent full-length article review; 22 were excluded, as they did not include controls or report the outcome of interest. A total of 39 observational studies [4,6,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47], including 7,099 patients, finally met our inclusion criteria and were included in the meta-analysis. Figure 1 outlines our search methodology and selection process; the baseline characteristics of the included studies are summarized in Table 1.…”

Post-transplant erythrocytosis after kidney transplantation: A review

“…PTE was first described in a case report from 1965 of a 22-year-old woman undergoing kidney transplantation with bilateral nephrectomy and splenectomy[ 4 ]. The incidence of PTE, as described in the literature, ranges from 8%-15%, with some studies as low as 2.2% and as high as 22.2%[ 3 , 5 , 6 ]. This variability can be explained partly by three main factors: (1) Lack of consensus regarding the definition of PTE; (2) The increase in use of angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARBs); and (3) Aggressive use of potent immunosuppressive agents, including mycophenolic acid (MPA) derivatives.…”

“…Age and pre-transplant dialysis need may also contribute to PTE as demonstrated in the following studies. In their study published in 2021, Alasfar et al [ 6 ] noted younger recipient, young donor age and polycystic kidney disease were risk factors associated with the development of PTE. In our own examination of PTE in KTRs at our institution, we found that non-preemptive transplant was significantly associated with the development of PTE [hazard ratio (HR) =2.32 (95%CI (confidence interval): 1.55-3.47), P < 0.001, on univariate analysis); HR = 3.86 (95%CI: 1.56-9.56) P = 0.003 on multivariate analysis)][ 41 ].…”