Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins School of Medicine, 1830 E. Monument St., Suite 416, Baltimore, MD, 21287, USA.
BMC Nephrol. 2021 Jan 12;22(1):26. doi: 10.1186/s12882-021-02231-2.
Post-Transplant erythrocytosis (PTE) has not been studied in large recent cohorts. In this study, we evaluated the incidence, risk factors, and outcome of PTE with current transplant practices using the present World Health Organization criteria to define erythrocytosis. We also tested the hypothesis that the risk of PTE is greater with higher-quality kidneys.
We utilized the Deceased Donor Study which is an ongoing, multicenter, observational study of deceased donors and their kidney recipients that were transplanted between 2010 and 2013 across 13 centers. Eryrthocytosis is defined by hemoglobin> 16.5 g/dL in men and> 16 g/dL in women. Kidney quality is measured by Kidney Donor Profile Index (KDPI).
Of the 1123 recipients qualified to be in this study, PTE was observed at a median of 18 months in 75 (6.6%) recipients. Compared to recipients without PTE, those with PTE were younger [mean 48±11 vs 54±13 years, p < 0.001], more likely to have polycystic kidney disease [17% vs 6%, p < 0.001], have received kidneys from younger donors [36 ±13 vs 41±15 years], and be on RAAS inhibitors [35% vs 22%, p < 0.001]. Recipients with PTE were less likely to have received kidneys from donors with hypertension [16% vs 32%, p = 0.004], diabetes [1% vs 11%, p = 0.008], and cerebrovascular event (24% vs 36%, p = 0.036). Higher KDPI was associated with decreased PTE risk [HR 0.98 (95% CI: 0.97-0.99)]. Over 60 months of follow-up, only 17 (36%) recipients had sustained PTE. There was no association between PTE and graft failure or mortality, CONCLUSIONS: The incidence of PTE was low in our study and PTE resolved in majority of patients. Lower KDPI increases risk of PTE. The underutilization of RAAS inhibitors in PTE patients raises the possibility of under-recognition of this phenomenon and should be explored in future studies.
近年来，尚未对大量的移植后红细胞增多症（PTE）病例进行研究。在这项研究中，我们使用目前的世界卫生组织标准来定义红细胞增多症，评估了当前的移植实践中 PTE 的发生率、危险因素和结果。我们还测试了一个假设，即高质量的肾脏会增加 PTE 的风险。
我们利用了尸体供者研究，这是一项正在进行的、多中心、观察性研究，涉及 2010 年至 2013 年间在 13 个中心接受移植的 1123 名尸体供者及其肾脏受者。红细胞增多症定义为男性血红蛋白>16.5 g/dL 和女性血红蛋白>16 g/dL。肾脏质量用肾脏供者特征指数（KDPI）来衡量。
在符合本研究条件的 1123 名受者中，有 75 名（6.6%）受者在中位数为 18 个月时出现 PTE。与没有 PTE 的受者相比，有 PTE 的受者更年轻[平均年龄 48±11 岁比 54±13 岁，p<0.001]，更可能患有多囊肾病[17%比 6%，p<0.001]，接受来自更年轻供者的肾脏[36±13 岁比 41±15 岁]，并接受肾素-血管紧张素-醛固酮系统抑制剂治疗[35%比 22%，p<0.001]。有 PTE 的受者接受来自患有高血压供者的肾脏的可能性较小[16%比 32%，p=0.004]、糖尿病[1%比 11%，p=0.008]和脑血管意外（24%比 36%，p=0.036）的可能性较小。较高的 KDPI 与降低 PTE 风险相关[HR 0.98（95%CI：0.97-0.99）]。在 60 个月的随访期间，只有 17 名（36%）受者持续存在 PTE。PTE 与移植物失败或死亡无关。
在我们的研究中，PTE 的发生率较低，大多数患者的 PTE 得到缓解。较低的 KDPI 会增加 PTE 的风险。PTE 患者中肾素-血管紧张素-醛固酮系统抑制剂的使用不足表明，这种现象可能未被充分认识，应在未来的研究中进行探讨。
