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Kidney Week

Abstract: PO2527

Incidence, Risk Factors, and Outcomes of Post-Transplant Erythrocytosis After Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Alzoubi, Beyann, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Kharel, Abish, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Osman, Fauzia, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Aziz, Fahad, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Garg, Neetika, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Mohamed, Maha A., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Djamali, Arjang, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Mandelbrot, Didier A., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Parajuli, Sandesh, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
Background

Post-transplant erythrocytosis(PTE) is a common condition after kidney transplantation. PTE is known to increase the risk of stroke, pulmonary embolism, and deep vein thrombosis, commonly called vascular thromboembolism(VTE). In the current era of immunosuppressive medication and management, the incidence, risk factors, and outcomes of PTE among kidney transplant recipients(KTR) is unknown.

Methods

This was a retrospective study among all adult KTRs transplanted at our university hospital between 01/2001 and 12/2016. All recipients in the PTE group had at least 2 consecutive Hct levels of >51 within the first 2 years of transplant. Controls were selected in a ratio of 5:1 using event density sampling. Patient survival, graft survival, and VTE incidence were outcomes of interest.

Results

Of 4317 kidney transplants during the study period, 214(5%) had PTE and were compared with 1035 controls. While comparing baseline characteristics between PTE and control, KTRs in the PTE group were more likely to be younger, male, have lower BMI, higher prevalence of diabetes as the cause of ESRD and receive a non-preemptive transplant. Similarly, looking at donor characteristics, the PTE group was likely to receive the kidney from a younger donor and have lower KDPI. The median interval from transplant to the diagnosis of PTE was 9.9 months (IQR 5.89). 13 (6.1%) in the PTE group and 71(6.9%) in control had VTE events. In the multivariable analysis, patients with older age (HR: 0.98, 95% CI 0.97-0.99, p=0.005) and higher BMI (HR: 0.97, 95% CI 0.93-0.99, p=0.05) were less likely to develop PTE, while non-preemptive transplant (HR: 3.95, 95% CI 1.74-8.99, p=0.001) was significantly associated with increased risk of PTE. After adjustment for the multiple confounding factors, PTE was not associated with patient mortality (HR: 1.0, 95% CI 0.70-1.43, p=0.99), graft failure (HR: 1.13, 95% CI 0.69-1.83, p=0.61) or VTE (HR: 1.07, 95% CI 0.59-1.96, p=0.81). In a subgroup analysis among PTE with Hct >55 (n=39) compared with controls, similar findings were observed.

Conclusion

In this era, the prevalence of PTE is lower at 5% compared to around 15% in various previous studies. Similarly, there were no detrimental effects of PTE on patient survival, graft survival, or the risk of VTE in the current era.