Post-transplant erythrocytosis after kidney transplantation: A review

Abstract

Post-transplant erythrocytosis (PTE) is defined as persistently elevated hemoglobin > 17 g/dL or hematocrit levels > 51% following kidney transplantation, independent of duration. It is a relatively common complication within 8 months to 24 months post-transplantation, occurring in 8%-15% of kidney transplant recipients. Established PTE risk factors include male gender, normal hemoglobin/hematocrit pre-transplant (suggestive of robust native kidney erythropoietin production), renal artery stenosis, patients with a well-functioning graft, and dialysis before transplantation. Many factors play a role in the development of PTE, however, underlying endogenous erythropoietin secretion pre-and post-transplant is significant. Other contributory factors include the renin-angiotensin- aldosterone system, insulin-like growth factors, endogenous androgens, and local renal hypoxia. Most patients with PTE experience mild symptoms like malaise, headache, fatigue, and dizziness. While prior investigations showed an increased risk of thromboembolic events, more recent evidence tells a different story-that PTE perhaps has lessened risk of thromboembolic events or negative graft outcomes than previously thought. In the evaluation of PTE, it is important to exclude other causes of erythrocytosis including malignancy before treatment. Angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) are the mainstays of treatment. Increased ACE-I/ARB use has likely contributed to the falling incidence of erythrocytosis. In this review article, we summarize the current literature in the field of post-transplant erythrocytosis after kidney transplantation.

Prevalence and Predisposing Factors of Post Renal Transplant Erythrocytosis

“…Results were comparable to the previous studies. [16,17] In our study, frequency of PTE was found in 23 (19.5%) cases and 95 (80.5%) cases were without PTE. Approximately 30% of individuals were found to have PTE in previous trials.…”

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

“…4 The median time to development of PTE in our study was 360 days, which is also in accordance with previous reports 5 There are a few predisposing risk factors that are thought to contribute to the development of PTE. Male gender is a well-established one, 15,31,33 with most studies showing much higher frequency of men among PTE patients. In our study, 90% of PTE patients were men, compared with only 64% male prevalence in the whole kidney transplanted population.…”

JAK2 unmutated erythrocytosis: 2023 Update on diagnosis and management

“…146,147 It usually develops within the first 2 years, with spontaneous resolution reported in one fourth of patients within 2 years of diagnosis. 146 Predisposing factors include male gender, preserved glomerular filtration rate, rejection-free course, retained native kidneys, long pretransplant dialysis course, absence of anemia pretransplant, renal artery stenosis, polycystic kidney disease, and glomerulonephritis. 146 In earlier studies, it was associated with increased risk of thromboembolic events, which has not been the case in a contemporary series.…”

“…146 Predisposing factors include male gender, preserved glomerular filtration rate, rejection-free course, retained native kidneys, long pretransplant dialysis course, absence of anemia pretransplant, renal artery stenosis, polycystic kidney disease, and glomerulonephritis. 146 In earlier studies, it was associated with increased risk of thromboembolic events, which has not been the case in a contemporary series. 148 The mechanism remains obscure but is felt to be multifactorial with excessive Epo production driven by renin-angiotensin, IGF-1, and endogenous androgens.…”