Erythrocytosis after liver transplantation: The experience of a university hospital

Cordone, G; Zingone, Fabiana; Cardillo, Giuseppe; Martinelli, Vincenzo; Pugliese, Novella; Pellegrini, Lucienne; Ciacci, Carolina; Parrilli, G.

doi:10.1002/lt.23606

Cited by 3 publications

(9 citation statements)

References 17 publications

(31 reference statements)

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“…Acquired erythrocytosis was also described in subjects with simultaneous kidney-pancreas transplant [7] and those with allogeneic hematopoietic stem cell transplantation [8,9]. Based on our knowledge, our group was the first and only to report in 2013 [10] post-transplant erythrocytosis in subjects with liver transplantation. We found that erythrocytosis appeared in 11 males with HBV among 96 adult patients who had undergone OLT for different causes.…”

Section: Introductionmentioning

confidence: 80%

The Hct values after liver transplantation

Zingone¹,

Santonicola²,

Mancusi³

et al. 2017

Gastroenterol Hepatol Endosc

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In the present study our aims are to evaluate the trend of the Hct values after liver transplantation and the prevalence of post-transplant erythrocytosis, as well as to detect, through a sub-analysis, if the switch to hepatitis B immune globulin therapy SC affects the Hct levels. We retrospectively analysed patients who had undergone liver transplantation and were still followed up at the Liver Following Transplantation Centre of the University of Salerno in December 2016. Our first analysis included 113 subjects. Among them, we identified eight patients with at least one manifestation of high Hct in the last year who needed phlebotomy with a prevalence of post-transplant erythrocytosis at 7.07% (8/113).All patients were male and had a HBV history, except one with a history of bile ducts atresia. We observed a progressive increase of Hct over time after OLT in all patients. In 2010, 13 HBV patients underwent the switch from hepatitis B immune globulin therapy EV/IM to hepatitis B immune globulin therapy SC, yet the change of formulation did not reduce the Hct values. Our findings show that Hct values increase over time in patients with liver transplantation, but they become pathological only in male patients with HBV infection.

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Section: Introductionmentioning

confidence: 80%

The Hct values after liver transplantation

Zingone¹,

Santonicola²,

Mancusi³

et al. 2017

Gastroenterol Hepatol Endosc

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“…In a cohort of 10 pediatric OLT recipients, 6 patients presented a transient increase in EPO level a few days after OLT, and 3 patients required phlebotomy to lower Hb and Hct levels. Interestingly, all patients were anemic and had normal EPO values before liver transplantation, thus suggesting that OLT would have determined an increase in EPO and erythrocytosis 13 .…”

Section: Discussionmentioning

confidence: 99%

“…In adult OLT recipients, idiopathic erythrocytosis has been reported in approximately 10% of patients. It occurs within the first two years after liver transplantation in HBV-positive cirrhotic males 13 . Our pediatric cohort presents lower incidence rates of PTE.…”

Section: Discussionmentioning

confidence: 99%

“…This is probably related to the different indications for OLT. No children have undergone OLT for HBV infection, while this is reported to be a strong risk factor in adults 13 .…”

Section: Discussionmentioning

confidence: 99%

“…While post-renal transplantation erythrocytosis has frequently been associated with significant thromboembolic events, and sometimes death 5 , no definitive data about the outcome of post-OLT erythrocytosis in adult patients have been reported. In the Italian cohort of 96 OLT recipients 13 , 11 patients developed erythrocytosis and underwent serial phlebotomy to maintain Hct <49%. There were no reports of cardiovascular events during the observation period; however, 3 out of 11 patients with erythrocytosis (27%) had a history of vascular complications several years after OLT.…”

Section: Discussionmentioning

confidence: 99%

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Juvenile erythrocytosis in children after liver transplantation: prevalence, risk factors and outcome

Casale

Roberti

Mandato

et al. 2020

Sci Rep

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Most reports of post-transplant erythrocytosis have involved kidney recipients and, so far, there have been no large studies of onset of erythrocytosis after orthotopic liver transplantation (oLt) in children. We present a long-term survey of pediatric liver recipients, evaluating prevalence, outcome and the main potential causes of erythrocytosis, including a comprehensive mutational analysis of commonly related genes (mutations of HBB and HBA, JAK2, EPOR, VHL, EPAS1 and EGLN1). Between 2000 and 2015, 90 pediatric OLT recipients were observed for a median period of 8.7 years (range 1-20.4 [IQR 4.9-13.6] years). Five percent of the study population (4 males and 1 female) developed erythrocytosis at 8.5 years post OLT (range 4.1-14.9 [IQR 4.7-14.7]) at a median age of 16.6 years (range 8.2-18.8 [IQR 11.7-17.7]). Erythrocytosis-free survival after OLT was 98.6% at 5 years, 95% at 10 years, and 85% at 15 years, with an incidence rate of 6/1000 person-years. No cardiovascular events or thrombosis were reported. no germinal mutation could be clearly related to the development of erythrocytosis. one patient, with high erythropoietin levels and acquired multiple bilateral renal cysts, developed clinical hyper-viscosity symptoms, and was treated with serial phlebotomies. in conclusion, this prospective longitudinal study showed that erythrocytosis is a rare complication occurring several years after oLt, typically during adolescence. erythrocytosis was non-progressive and manageable. its pathogenesis is still not completely understood, although male gender, pubertal age, and renal cysts probably play a role. Erythrocytosis is defined by an increase in red-cell mass to >125% of the predicted valued according to sex and body mass 1. In adults, hematocrit (Hct) >56% in females and 60% in males has been considered sufficient to define the condition of absolute erythrocytosis 2 , although the World Health Organization has now proposed lower levels among the criteria for Polycythemia Vera (i.e. Hct > 49% or >48% and Hemoglobin [Hb] > 16.5 g/ dL or >16 g/dL, respectively, for males and females) 3. In children, diagnosis can be challenging as it relies on Hb and Hct percentiles and cutoff values that vary according to age and sex, even though fixed cut off criteria are used for adults. Furthermore, some diagnostic tests for erythrocytosis may require specific procedures for use in pediatric populations, making them more complex and expensive than those used in adults 4. The main concern related to erythrocytosis in the general population, and especially in patients undergoing organ transplantation, is the risk for cardiovascular events and death, as erythrocytosis can affect transplant outcome and lead to long-term complications 5. Erythrocytosis is quite a common complication after renal transplants with a prevalence of 10-15% 5 , varying from as low as 3.2% in children 6 to as high as 20.2% in adults 5-7. Erythropoietin (EPO), renin-angiotensin system, insulin-like growth factor, male gender and renal cysts are some of the fac...

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Secondary Erythrocytosis, a Predominant Cause of Polycythemia- Clinical and Laboratory Evaluation of Polycythemia in a Tertiary Care Center

Aamir,

Mushtaq,

Sheikh

2023

IBRR

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Aims: Polycythemia refers to an increased production of red blood cells from bone marrow. It is one of the frequent reasons for a hematology consultation. The present work aimed to examine the causes, clinical manifestations, prevalence, and diverse patterns in laboratory and clinical parameters among patients with polycythemia attending our outpatient clinics at the Indus Hospital and Health Network. Study Design: The present work is retrospective observational study which included all cases of polycythemia. Place and Duration of the Study: The study was conducted at a tertiary health care center in Karachi, Pakistan during October 2019 to July 2021. Methodology: The data from the patient diagnosed with polycythemia was entered and analyzed by using SPSS version 24.0. Descriptive statistics as per the Gaussian Normality distribution (Sapiro-Wilk) were computed along with frequencies. The association where applicable was calculated via standard statistical methods with the chi square test for categorical while independent sample t-test for the continuous variables. The level of statistical significance will be set at P < 0.05. Results: During the investigated period, a total of 33 patients were diagnosed with polycythemia demonstrating a notable male predominance (82%). The majority of the patients exhibited secondary erythrocytosis (85%) with only a minority (15%) diagnosed with polycythemia vera. Of the identified cases of secondary erythrocytosis a significant proportion (46%) was observed in individuals who were smokers while other were found with hypoxic pulmonary disease, hepatitis, and chronic kidney disease. In secondary erythrocytosis 21 patients (75%) required venesection for symptom reduction, while 7 (25%) were closely monitored due to their asymptomatic status. On the contrary all cases of polycythemia vera required a comprehensive treatment approach including venesections, cytoreduction with hydroxyurea and low dose aspirin.

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Erythrocytosis after liver transplantation: The experience of a university hospital

Cited by 3 publications

References 17 publications

The Hct values after liver transplantation

The Hct values after liver transplantation

Juvenile erythrocytosis in children after liver transplantation: prevalence, risk factors and outcome

Secondary Erythrocytosis, a Predominant Cause of Polycythemia- Clinical and Laboratory Evaluation of Polycythemia in a Tertiary Care Center

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