Alzoubi B, Kharel A, Machhi R, Aziz F, Swanson KJ, Parajuli S. Post-transplant erythrocytosis after kidney transplantation: A review. World J Transplant 2021; 11(6): 220-230 [PMID: 34164297 DOI: 10.5500/wjt.v11.i6.220]
Corresponding Author of This Article
Kurtis J Swanson, MD, Academic Fellow, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Madison, 600 Highland Ave, Madison, WI 53705, United States. kswanson@uwhealth.org
Research Domain of This Article
Transplantation
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Beyann Alzoubi, Abish Kharel, Rushad Machhi, Fahad Aziz, Kurtis J Swanson, Sandesh Parajuli, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI 53705, United States
Author contributions: Alzoubi B, Kharel A, Machhi R, Swanson KJ and Parajuli S had an original idea, designed the study, reviewed literature, prepared the manuscript; Aziz F edited the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kurtis J Swanson, MD, Academic Fellow, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Madison, 600 Highland Ave, Madison, WI 53705, United States. kswanson@uwhealth.org
Received: February 27, 2021 Peer-review started: February 27, 2021 First decision: May 5, 2021 Revised: May 17, 2021 Accepted: May 24, 2021 Article in press: May 24, 2021 Published online: June 18, 2021
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.
Core Tip: Post-transplant erythrocytosis is an important disease process after kidney transplantation that manifests in a typical population based on risk factors, responds well to pharmacotherapy in most cases, and over time, has led to minor sequelae and favorable outcomes with minimal impact on patient and allograft survival. It is important to recognize this disease for appropriate management as well as investigation for other more ominous causes of erythrocytosis, namely malignancy.
