Post-transplant erythrocytosis after kidney transplantation: A review

Table 1 Post-transplant erythrocytosis management guidelines

Ref.	Society	Recommendations
KDIGO Transplant Work Group[11], 2009	KDIGO	Definition of erythrocytosis: hemoglobin > 17 g/dL or hematocrit > 51%. Recommend using ACE-Is or ARBs for initial treatment of erythrocytosis.
Bia et al[12], 2010	NKF/KDOQI	Recommend treatment when hemoglobin > 17-19 g/dL or hematocrit > 51%-52%. Treatment guidelines per 2009 KDIGO recommendations.
Baker et al[13], 2017	The Renal Association	Recommend treatment when hematocrit > 52% in males and > 49% in females. Recommended first line treatment is ACE-I or ARBs.
McMullin et al[14], 2019	British Society of Hematology	Treat if hematocrit is persistently elevated for > 1 mo with ACE-I or ARB. Therapeutic phlebotomy can be used for persistent symptoms, but there is no evidence of benefit. No evidence for aspirin as an effective treatment.

KDIGO: Kidney Disease Improving Global Outcomes; ACE-I: Angiotensin converting enzyme inhibitors; ARB: Angiotensin receptor blocker; NKF: National Kidney Foundation; KDOQI: Kidney Disease Outcomes Quality Initiative.

Table 2 Effect on hemoglobin and hematocrit after use of angiotensin converting enzyme inhibitor/angiotensin receptor blocker

Ref.	Number of patients	Hgb pre (g/dL)	Hgb post (g/dL)	P value	Hct pre (%)	Hct post (%)	P value	Drug (mg/d)	Duration (wk)
Islam et al[15], 1990	7				56	45	< 0.001	Captopril 75	NA
Conlon et al[16], 1993	11				52	46	< 0.05	Enalapril 2.5	12
Rell et al[17], 1994	17				51	43	< 0.01	Enalapril 20	12
Wong et al[18], 1994	14				53	44	< 0.0001	Enalapril 2.5-5
Torregrosa et al[19], 1994	19				56	47	< 0.001	Captopril 25	12
Danovitch et al[20], 1995	15				53	46	< 0.001	Enalapril 5	8
Hernández et al[21], 1995	21				58	49	< 0.01	Captopril NA	24
Mulhern et al[22], 1995	8				54	43	< 0.05	Enalapril 8.5	12
Perazella et al [23], 1995	10				52	44	= 0.001	Enalapril 3.5	24
Rostaing et al [24], 1995	12				51	42	< 0.001	Enalapril 14	6
Ok et al[25], 1995	10				57	45		Enalapril 10	8
Conlon et al[26], 1996	7				55	49	0.001	Losartan 50	12
Morrone et al[27], 1997	20				52	48	< 0.05	Enalapril 10	NA
Ducloux et al[28], 1998	4				52	38	< 0.0005	Losartan 100	12
Mazzali and Filho[29], 1998	27				56	46	< 0.05	Enalapril 5	12
Julian et al[30], 1998	23				53	49	< 0.01	Losartan	8
Montanaro et al[31], 2000	11				54	46	< 0.01	NA	NA
Glicklich et al[32], 2001	10				53	45	< 0.01	Lisinopril or fosinopril	6.8
Trivedi et al[33], 2003	9	17.2 ± 0.6	14.9 ± 1.4	0.0023	51.3 ± 2.4	43.7 ± 4.6	0.003	Fosinopril, 10-20	12
Stoll et al[34], 2004	1	20.7	18.2	NA	58	53	NA	Losartan, 25-50	8
Esposito et al[35], 2007	27	16.5	15	< 0.0001	52	45.2	< 0.0001	Ramipril, 1.5-10	52
Bravo et al[36], 2008	6	15.9	14.5 ± 0.7	0.001				Lisinopril 1.5-5	52
Ahmed et al[37], 2012	12	16.79 ± 0.75	15.17 ± 1.72	NA	54.78 ± 1.96	48.61 ± 1.85	NA	Enalapril	NA
Almonte et al[38], 2015	1	17.5	15	NA	53	44.5	NA	Enalapril 0.13 mg/kg/d	24

Hgb: Hemoglobin; Hct: Hematocrit; NA: Not available.

Table 3 Effect on hemoglobin and hematocrit after use of theophylline

Ref.	Number of patients	Hgb pre	Hgb post	P value	Hct pre	Hct post	P value	Drug (mg/d)	Duration (wk)
Bakris et al[61], 1990	8				58	46	< 0.05	Theophylline	8
Grekas et al[62], 1995	8				58	50	< 0.05	Theophylline 600	8
Ok et al[25], 1995	9				56	52	NA	Theophylline 600	8
Yagisawa et al[63], 1996	1				50.3	53.5	NA	Theophylline	4
Trivedi et al[33], 2003	5	17.4 ± 0.7	18.1 ± 0.9	> 0.05	52.4 ± 2.7	54.7 ± 3.9	> 0.05	Theophylline	12

Hgb: Hemoglobin; Hct: Hematocrit; NA: Not available.