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Posttransplant erythrocytosis
Demetrios V Vlahakos1, Katerina P Marathias, Basil Agroyannis
1Department of Nephrology, Aretaieion University Hospital and Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece. vlahakos@aretaieio.uoa.gr
Kidney International
|March 13, 2003
Summary
Posttransplant erythrocytosis (PTE) is an elevated hematocrit after kidney transplant. Inactivating the renin-angiotensin system with ACE inhibitors or ARBs is an effective treatment.
Area of Science:
- Nephrology
- Hematology
- Transplantation
Background:
- Posttransplant erythrocytosis (PTE) affects 10-15% of kidney transplant recipients, typically 8-24 months post-engraftment.
- While spontaneous remission occurs in 25% of cases, PTE often persists, leading to complications like thrombosis and potentially graft loss.
- PTE is characterized by elevated hematocrit (>51%) and associated symptoms including headache, lethargy, and dizziness.
Purpose of the Study:
- To investigate the underlying mechanisms of posttransplant erythrocytosis.
- To identify predisposing factors and clinical manifestations of PTE.
- To evaluate therapeutic strategies for managing PTE.
Main Methods:
- Review of existing literature on posttransplant erythrocytosis.
- Analysis of predisposing factors such as male gender, native kidney retention, and smoking.
- Examination of erythropoietic factors including erythropoietin, angiotensin II, and IGF-1.
Main Results:
- PTE pathogenesis involves multiple erythropoietic factors, with endogenous erythropoietin playing a central role.
- Tertiary hypererythropoietinemia from native kidneys contributes, alongside other factors like angiotensin II and IGF-1.
- Thromboembolic events occur in 10-30% of PTE cases, with a mortality rate of 1-2%.
Conclusions:
- Inactivation of the renin-angiotensin system (RAS) via ACE inhibitors or AT1 receptor blockers is the most effective treatment for PTE.
- RAS blockade offers a safe and well-tolerated therapeutic approach.
- Understanding PTE's multifactorial etiology guides effective management strategies.