Besarab A, Caro J, Jarrell B E, Francos G, Erslev A J
Department of Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
Kidney Int. 1987 Oct;32(4):526-36. doi: 10.1038/ki.1987.241.
We examined the temporal dynamics of the correction of anemia following renal transplantation in 65 recipients using a sensitive radioimmunoassay for erythropoietin to determine the effects of modern immunosuppressive agents, delayed graft function, and early acute rejection. Pretransplant mean erythropoietin (25.6 +/- 3.3 mU/ml) was only 25% of the expected value at the mean hematocrit of 27.2 +/- 0.7, and erythropoietin correlated positively with hematocrit (r = 0.37, P less than 0.05). Following onset of graft function, erythropoietin increased to 109 +/- 13 mU/ml and then decreased in a negative feedback fashion over the next several months. Delayed graft function was associated with delay in the assumption of this orderly process irrespective of the immunosuppressive regimen used. Cyclosporine A produced a biphasic response despite delayed graft function in recipients with underlying adult polycystic kidney disease. Correction of anemia required resumption of graft function. Onset of acute graft rejection within the first month posttransplantation (14 episodes in 11 patients) abrogated the hematopoietic response until the rejection was successfully reversed. We conclude that a major cause for the anemia of renal failure is subnormal production of erythropoietin. Following transplantation, anemia corrects in an orderly manner with restoration of the normal biofeedback process between erythropoietin and red cell mass. This process is delayed by failure of graft to function initially and interrupted by acute early rejection, re-commencing following successful reversal.
我们使用一种敏感的促红细胞生成素放射免疫分析法，研究了65例肾移植受者肾移植后贫血纠正的时间动态变化，以确定现代免疫抑制剂、移植肾功能延迟及早期急性排斥反应的影响。移植前促红细胞生成素的平均水平（25.6±3.3 mU/ml）仅为平均血细胞比容27.2±0.7时预期值的25%，且促红细胞生成素与血细胞比容呈正相关（r = 0.37，P<0.05）。移植肾功能开始恢复后，促红细胞生成素升高至109±13 mU/ml，随后在接下来的几个月以负反馈方式下降。移植肾功能延迟与这一有序过程的延迟有关，与所使用的免疫抑制方案无关。尽管患有成人多囊肾的受者存在移植肾功能延迟，但环孢素A仍产生了双相反应。贫血的纠正需要移植肾功能的恢复。移植后第一个月内发生的急性移植排斥反应（11例患者中有14次发作）会消除造血反应，直至排斥反应成功逆转。我们得出结论，肾衰竭贫血的主要原因是促红细胞生成素生成不足。移植后，随着促红细胞生成素与红细胞量之间正常生物反馈过程的恢复，贫血会有序纠正。这一过程因移植肾最初功能障碍而延迟，并因早期急性排斥反应而中断，在成功逆转后重新开始。
