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

Hofstetter, Liron; Rozen‐Zvi, Benaya; Schechter, Amir; Raanani, Pia; Itzhaki, Oranit; Rahamimov, Ruth; Gafter‐Gvili, Anat

doi:10.1111/ejh.13696

Cited by 6 publications

(5 citation statements)

References 25 publications

(46 reference statements)

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“…Recent research indicates a reassuring trend: PTE does not negatively affect kidney graft survival among kidney transplant recipients. 2,11,20 Our analysis extends this trend to SPKT recipients showing no association between PTE and pancreas or kidney graft failure. However, we found that SPKT recipients who were non-White were over twice as likely to experience kidney graft failure.…”

Section: Discussionsupporting

confidence: 69%

“…Additionally, our larger sample size of 887 SPKT recipients compared with 94 SPKT recipients in the study by Guerra et Recognized risk factors of PTE include male gender, retention of native kidney erythropoietin production, renal artery stenosis, and preserved GFR. 1,3,5,7,[10][11][12][13][18][19][20][21] Smoking history, pretransplant dialysis, and diabetes are associated with PTE in some studies. 1,12,21,22 Our study reaffirms male gender as a risk factor for the development of PTE.…”

Section: Discussionmentioning

confidence: 99%

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Incidence, Risk Factors, and Outcomes of Posttransplant Erythrocytosis Among Simultaneous Pancreas-Kidney Transplant Recipients

Gibes,

Astor,

Odorico

et al. 2024

Transplantation Direct

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Background. Posttransplant erythrocytosis (PTE) is a well-known complication of kidney transplantation. However, the risk and outcomes of PTE among simultaneous pancreas-kidney transplant (SPKT) recipients are poorly described. Methods. We analyzed all SPKT recipients at our center between 1998 and 2021. PTE was defined as at least 2 consecutive hematocrit levels of >51% within the first 2 y of transplant. Controls were selected at a ratio of 3:1 at the time of PTE occurrence using event density sampling. Risk factors for PTE and post-PTE graft survival were identified. Results. Of 887 SPKT recipients, 108 (12%) developed PTE at a median of 273 d (interquartile range, 160–393) after transplantation. The incidence rate of PTE was 7.5 per 100 person-years. Multivariate analysis found pretransplant dialysis (hazard ratio [HR]: 3.15; 95% confidence interval [CI], 1.67-5.92; P < 0.001), non-White donor (HR: 2.14; 95% CI, 1.25-3.66; P = 0.01), female donor (HR: 1.50; 95% CI, 1.0-2.26; P = 0.05), and male recipient (HR: 2.33; 95% CI, 1.43-3.70; P = 0.001) to be associated with increased risk. The 108 cases of PTE were compared with 324 controls. PTE was not associated with subsequent pancreas graft failure (HR: 1.36; 95% CI, 0.51-3.68; P = 0.53) or kidney graft failure (HR: 1.16; 95% CI, 0.40-3.42; P = 0.78). Conclusions. PTE is a common complication among SPKT recipients, even in the modern era of immunosuppression. PTE among SPKT recipients was not associated with adverse graft outcomes, likely due to appropriate management.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors, and Outcomes of Posttransplant Erythrocytosis Among Simultaneous Pancreas-Kidney Transplant Recipients

Gibes,

Astor,

Odorico

et al. 2024

Transplantation Direct

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“…Same study showed its prevalence among diabetic patients, smokers and rejection free recipients. Another study showed that 16% had developed Erythrocytosis and they reported about pre-transplant hematocrits in their history [18][19] . The level of serum erythropoietin was elevated in these patients.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Post-Transplant Erythrocytosis in Patients with Live Related Renal Transplant

Chandio¹,

Shoaib²,

Jamro³

2023

PJMHS

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Background: It is commonly observed in the patients undergoing kidney transplant. The red cell mass increased in this condition but the plasma volume remain normal. It is characterized by the hematocrit levels equal to 51% or greater than 51%. Study design: It was a cross-sectional and descriptive study conducted at the department of nephrology and transplantation, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Gambat. This study was conducted for the duration of six months from January 2022 to June 2022. Material and Methods: There were total 90 patients selected for the study. There were 35 patients in the control group and 55 patients in the Post-transplant Erythrocytosis patients group. The 25 out of 35 were male and 7 were females. The 17 out of 55 were male and 38 were females. Haemoglobin and Hematocrit was assessed retrospectively. Those with Hct > 51 was labelled as PTE. The study comprised of control group and PTE group having post erythrocytosis patients. The duration of dialysis of the patients was 12 and 13 months for control and PTE group respectively. Results: The red cell and plasma volume of the control group and PTE was analyzed and it showed that most of the patients had their RCV and PV in the normal range. However, there were 5 patients in control group and 15 patients in PTE group that had reported low level of RCV. The percentage of alive patients with functional graft was more in case of control (97%) as compared to PTE group (83%). Conclusion: The study was done to find the frequency of post-transplant Erythrocytosis among patients and control group. It was found that there were several risk factors that could possibly play role in causing the disease. The 21% of the patients were diagnosed with PTE. Keywords: Erthrocytosis, haematocrit, and haemoglobin.

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“…The incidence of postrenal transplant erythrocytosis ranges from 8% to 15% and is declining with widespread use of angiotensinconverting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB). 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.…”

Section: Erythrocytosis Associated With Renal Transplantmentioning

confidence: 99%

“…The incidence of postrenal transplant erythrocytosis ranges from 8% to 15% and is declining with widespread use of angiotensin‐converting enzyme inhibitors (ACE‐I) and angiotensin receptor blockers (ARB) 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 .…”

Section: Diagnostic Approach To Acquired Erythrocytosismentioning

confidence: 99%

JAK2 unmutated erythrocytosis: 2023 Update on diagnosis and management

2023

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Disease Overview JAK2 unmutated or non‐polycythemia vera (PV) erythrocytosis encompasses a heterogenous spectrum of hereditary and acquired entities. Diagnosis Foremost in the evaluation of erythrocytosis is the exclusion of PV through JAK2 (inclusive of exons 12–15) mutation screening. Initial assessment should also include gathering of previous records on hematocrit (Hct) and hemoglobin (Hgb) levels, in order to streamline the diagnostic process by first distinguishing longstanding from acquired erythrocytosis; subsequent subcategorization is facilitated by serum erythropoietin (Epo) measurement, germline mutation screening, and review of historical data, including comorbid conditions and medication list. Hereditary erythrocytosis constitutes the main culprit in the context of longstanding erythrocytosis, especially when associated with a positive family history. In this regard, a subnormal serum Epo level suggests EPO receptor mutation. Otherwise, considerations include those associated with decreased (high oxygen affinity Hgb variants, 2,3‐bisphosphoglycerate deficiency, PIEZO1 mutations, methemoglobinemia) or normal oxygen tension at 50% Hgb saturation (P50). The latter include germline oxygen sensing pathway (HIF2A–PHD2–VHL) and other rare mutations. Acquired erythrocytosis commonly results from central (e.g., cardiopulmonary disease, high‐altitude habitat) or peripheral (e.g., renal artery stenosis) hypoxia. Other noteworthy conditions associated with acquired erythrocytosis include Epo‐producing tumors (e.g., renal cell carcinoma, cerebral hemangioblastoma) and drugs (e.g., testosterone, erythropoiesis stimulating agents, sodium‐glucose cotransporter‐2 inhibitors). Idiopathic erythrocytosis is an ill‐defined terminology that presumes the existence of an increased Hgb/Hct level without an identifiable etiology. Such classification often lacks accounting for normal outliers and is marred by truncated diagnostic evaluation. Management Current consensus treatment guidelines are not supported by hard evidence and their value is further undermined by limited phenotypic characterization and unfounded concerns for thrombosis. We are of the opinion that cytoreductive therapy and indiscriminate use of phlebotomy should be avoided in the treatment of non‐clonal erythrocytosis. However, it is reasonable to consider therapeutic phlebotomy if one were to demonstrate value in symptom control, with frequency determined by symptoms rather than Hct level. In addition, cardiovascular risk optimization and low dose aspirin is often advised. Future Directions Advances in molecular hematology might result in better characterization of “idiopathic erythrocytosis” and expansion of the repertoire for germline mutations in hereditary erythrocytosis. Prospective controlled studies are needed to clarify potential pathology from JAK2 unmutated erythrocytosis, as well as to document the therapeutic value of phlebotomy.

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

Cited by 6 publications

References 25 publications

Incidence, Risk Factors, and Outcomes of Posttransplant Erythrocytosis Among Simultaneous Pancreas-Kidney Transplant Recipients

Incidence, Risk Factors, and Outcomes of Posttransplant Erythrocytosis Among Simultaneous Pancreas-Kidney Transplant Recipients

Frequency of Post-Transplant Erythrocytosis in Patients with Live Related Renal Transplant

JAK2 unmutated erythrocytosis: 2023 Update on diagnosis and management

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