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Kidney Week

Abstract: PO2511

A Retrospective Analysis of Post-Transplant Erythrocytosis: The Experience of a Tertiary Kidney Transplant Unit

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Deoraj, Stuart R., Guy's and Saint Thomas' Hospitals NHS Trust, Guy's and Saint Thomas' NHS Foundation Trust, London, London, United Kingdom
  • Ganjavian, Sophie, Guy's and Saint Thomas' Hospitals NHS Trust, Guy's and Saint Thomas' NHS Foundation Trust, London, London, United Kingdom
  • Asgari, Elham, Guy's and Saint Thomas' Hospitals NHS Trust, Guy's and Saint Thomas' NHS Foundation Trust, London, London, United Kingdom
Background

Post-transplant erythrocytosis (PTE) defined as persistently raised haemoglobin and haematocrit levels for over 6 months following kidney transplantation reportedly occurs in up to 20% of transplants and can influence physical and mental wellbeing. Reported complications include stroke, hypertension, NODAT and chronic fatigue. Our aim was to investigate the prevalence and potential risk factors of PTE in patients transplanted in our unit between 2013 and 2018.

Methods

We conducted a retrospective study of patients receiving a Kidney or Kidney-pancreas Transplant between 2013 and 2018 and followed up in our local clinic. We collected information on donor and recipient demographics, original kidney disease, transplant type, CMV transmission, HLA mismatch and Immune-suppression. Independent t-tests were used to analyse age, haemoglobin, haematocrit and ischaemic time. Odds ratios were used for ethnicity, transplant type, index disease and pre-transplant mode of renal replacement therapy (RRT).

Results

Of 568 transplant patients, 46(8%) fulfilled the criteria for PTE given sustained haematocrit >0.5 with a haemoglobin of approximately 161g/L (std. 9.9). We found the risk of PTE was significantly higher in men compared to women (OR 5.375 CI 2.24-12.9 p<0.05) and in DCD SPK transplants compared to other types (OR 5.57, p<0.05). The average age of donors to patients developing PTE was 6.5 years younger than the non-PTE group, p=0.008. IgA nephropathy appeared to convey a higher risk of developing PTE (OR 2.296 p=0.04), as did pre-transplant haemodialysis (OR 3.48 CI 1.34-9.02 p= 0.01). Recipient age, CMV transmission, HLA mismatch, ischaemic times, immune-suppression and prior transplants did not convey significant risk for PTE. Increased incidence of PTE in SPK transplant patients has been previously described. To the best of our knowledge, this is the first study highlighting a potential relationship between PTE and IgA nephropathy, but should be interpreted with caution as a larger study is needed for confirmation.

Conclusion

Although PTE is relatively common after kidney transplant, an understanding of its pathophysiology, epidemiology and prediction remains poor. Our study demonstrates a statistically significant increased risk of developing PTE among men, persons with IgA nephropathy and DCD SPK recipients, particularly from young donors.