Theophylline Modulates Erythrocytosis after Renal Transplantation

Grekas, Dimitrios; Dioudis, C; Valkouma, D.; Papoulidou, Fani; Tourkantonis, A.

doi:10.1159/000188539

Cited by 10 publications

(5 citation statements)

References 5 publications

(13 reference statements)

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“…The nonsignificant association in the KT outcomes may be because of an excellent response to treatment or good prognosis of PTE in general. As most of the patients included in our studies already received treatment and responded well to treatment with ACEI/ARB [5,67,68], phlebotomy [69], and/or theophylline [70][71][72]. The other reasons may be because of small sample size or short duration of follow-up.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Post-transplant erythrocytosis (PTE) can occur in up to 10-16% after kidney transplant (KT). However, the post-transplant outcomes of recipients with PTE in the literature were conflicting. We performed systematic review and meta-analysis of published studies to evaluate risk factors of PTE as well as outcomes of recipients who developed PTE compared with controls. A literature search was conducted evaluating all literature from existence through February 2, 2021, using MEDLINE and EMBASE. Data from each study were combined using the random-effects model. (PROS-PERO: CRD42021230377). Thirty-nine studies from July 1982 to January 2021 were included (7,099 KT recipients). The following factors were associated with PTE development: male gender (pooled RR = 1.62 [1.38, 1.91], I 2 = 39%), deceased-donor KT (pooled RR = 1.18 [1.03, 1.35], I 2 = 32%), history of smoking (pooled RR = 1.36 [1.11, 1.67], I 2 = 13%), underlying polycystic kidney disease (PKD) (pooled RR=1.56 [1.21,2.01], I 2 =44%), and pretransplant dialysis (pooled RR=1.6 [1.02, 2.51], I 2 =46%). However, PTE was not associated with outcomes of interest, including overall mortality, death-censored graft failure, and thromboembolism. Our metaanalysis demonstrates that male gender, deceased-donor KT, history of smoking, underlying PKD, and pretransplant dialysis were significantly associated with developing PTE. However, with proper management, PTE has no impact on prognosis of KT patients.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…Theophylline has had varied results in several studies. As described in 3 studies, theophylline has been shown to decrease Hct by 4%-15% in patients with PTE[ 61 , 62 , 64 ]. Notably, in the 2 studies cited whereby Hct after theophylline administration, one was case report ( n = 1) who discontinued theophylline after four weeks due to side effects, while the other study (Trivedi et al [ 33 ]) showed an increase in Hct that was not statistically significant[ 63 ].…”

Section: Treatmentmentioning

confidence: 99%

Post-transplant erythrocytosis after kidney transplantation: A review

Alzoubi

Kharel

Machhi

et al. 2021

WJT

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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.

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“…Hemoglobin levels decreased significantly in both groups (174–149 g/L for enalapril and 171–159 g/L for losartan); however, the drop was greater (p = 0.05) with enalapril (32.6 g/L decrease) than losartan (17.0 g/L decrease). Theophylline has been found to be useful in the transplant population with dramatic absolute reductions in hematocrit of 8–12% (798,799). However, several trials have found that ACE‐Is were superior when compared directly to theophylline (800–802).…”

Section: Rationalementioning

confidence: 99%

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Eckardt¹,

Kasiske²,

Zeier³

2009

American Journal of Transplantation

1,169

294

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Journal compilation © 2009 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/j.1600-6143.2009.02834.x S2 American Journal of Transplantation 2009; 9 (Suppl 3): S2-S2Since the first successful kidney transplantation in 1954 It is our hope that this document will serve several useful purposes. Our primary goal is to improve patient care. We hope to accomplish this in the short term by helping clinicians know and better understand the evidence (or lack of evidence) that determines current practice. By making this guideline broadly applicable, our purpose is to also encourage and enable the establishment and development of transplant programs worldwide. Finally, by providing comprehensive evidence-based recommendations, this guideline will also help define areas where evidence is lacking and research is needed. Helping to define a research agenda is an often neglected, but very important function of clinical practice guideline development.We used the GRADE system to rate the strength of evidence and the strength of recommendations. In all, there were only 4 (2%) recommendations in this guideline for which the overall quality of evidence was graded 'A,' whereas 27 (13.6%) were graded 'B,' 77 (38.9%) were graded 'C,' and 90 (45.5%) ' and 148 (74.7%) graded '2.' There were 3 (1.5%) recommendations graded '1A,' 16 (8.1%) were '1B,' 18 (9.1%) were '1C, ' and 13 (6.6%) were '1D.' There was 1 (0.5%) graded '2A,' 11 (5.6%) were '2B,' 59 (29.8%) were '2C, ' and 77 (38.9%) BackgroundExcept perhaps for transplantation between identical twins, all kidney transplant recipients (KTRs) need immunosuppressive medications to prevent rejection. Induction therapy is treatment with a biologic agent, either a lymphocyte-depleting agent or an interleukin 2 receptor antagonist (IL2-RA), begun before, at the time of, or immediately after transplantation. The purpose of induction therapy is to deplete or modulate T-cell responses at the time of antigen presentation. Induction therapy is intended to improve the efficacy of immunosuppression by reducing acute rejection, or by allowing a reduction of other components of the regimen, such as calcineurin inhibitors (CNIs) or corticosteroids. Available lymphocytedepleting agents include antithymocyte globulin (ATG), antilymphocyte globulin (ALG) and monomurab-CD3. Basiliximab and daclizumab, the two IL2-RAs that are currently available in many parts of the world, bind the CD25 antigen (interleukin-2 [IL2] receptor a-chain) at the surface of activated T-lymphocytes and thereby competitively inhibit IL2-mediated lymphocyte activation, a crucial phase in cellular immune response of allograft rejection. Rationale• There is high-quality evidence that the benefits of IL2-RA vs. no IL2-RA (or placebo) outweigh harm in a broad range of KTRs with variable immunological risk and concomitant immunosuppressive medication regimens.• There is moderate-quality evidence that a lymphocytedepleting agent vs. no lymphocyte-depleting a...

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Theophylline Modulates Erythrocytosis after Renal Transplantation

Cited by 10 publications

References 5 publications

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

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

Post-transplant erythrocytosis after kidney transplantation: A review

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

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