Kessler M, Hestin D, Mayeux D, Mertes P M, Renoult E
Department of Nephrology, University of Nancy, France.
Clin Nephrol. 1996 Feb;45(2):83-9.
We conducted a prospective study on 81 consecutive patients who had a kidney transplant with graft function for over 3 months to evaluate the prevalence of erythrocytosis following renal transplantation (PTE) and its potential risk factors. True PTE was defined as a RBC mass > 120% of the theoretical value allowing for sex, weight and height. 18 patients (22.2%) developed PTE (RBC mass = 157 +/- 21%) with no evidence of polycythemia vera (PV), or secondary polycythemia due to reduced arterial oxygen, kidney or hepatic tumors. PTE was more common in males (p = 0.041) and less common in patients treated with recombinant erythropoietin (rHEPO) prior to transplantation. 18 non-polycythemic patients (Hb 12.6 +/- 1.3 g/dl) matched for sex, age and renal function were used as case controls. Fewer PTE patients were transfused post-transplantation (p = 0.026). At the time of diagnosis, mean serum EPO was normal and similar to that of controls. PTE patients had lower serum ferritin (p = 0.005) and more commonly received iron supplementation when PTE occurred (p = 0.003). Other clinical factors did not differ significantly between the two groups. Two patients had a thrombotic event, 6 recovered spontaneously and 11 were successfully treated with angiotensin-converting enzyme inhibitors (ACEI). The normalization of Hb, hematocrit and RBC mass in ACEI treated patients was accompanied by a decline in serum EPO (p = 0.008). We conclude that true erythrocytosis is prevalent in cyclosporine-treated renal transplant patients. PTE seems to be an idiopathic erythrocytosis. Pretransplant rHEPO treatment may limit PTE by blunting the increased sensitivity of erythroid precursors to EPO and iron supplementation, which stimulates the development of PTE. ACEI treatment is effective and safe.
我们对81例肾移植后移植肾功能超过3个月的连续患者进行了一项前瞻性研究，以评估肾移植后红细胞增多症（PTE）的患病率及其潜在危险因素。真正的PTE定义为红细胞量超过根据性别、体重和身高计算的理论值的120%。18例患者（22.2%）发生了PTE（红细胞量=157±21%），且无真性红细胞增多症（PV）或因动脉血氧降低、肾脏或肝脏肿瘤导致的继发性红细胞增多症的证据。PTE在男性中更常见（p=0.041），而在移植前接受重组促红细胞生成素（rHEPO）治疗的患者中较少见。选取18例非红细胞增多症患者（血红蛋白12.6±1.3g/dl）作为病例对照，这些患者在性别、年龄和肾功能方面相匹配。PTE患者移植后输血较少（p=0.026）。在诊断时，PTE患者的平均血清促红细胞生成素（EPO）正常，与对照组相似。PTE患者的血清铁蛋白较低（p=0.005），且在发生PTE时更常接受铁补充剂治疗（p=0.003）。两组之间的其他临床因素无显著差异。2例患者发生血栓事件，6例自发恢复，11例成功接受血管紧张素转换酶抑制剂（ACEI）治疗。ACEI治疗患者的血红蛋白、血细胞比容和红细胞量恢复正常的同时，血清EPO下降（p=0.008）。我们得出结论，真正的红细胞增多症在接受环孢素治疗的肾移植患者中很普遍。PTE似乎是一种特发性红细胞增多症。移植前rHEPO治疗可能通过减弱红系前体细胞对EPO的敏感性增加来限制PTE，而铁补充剂会刺激PTE的发展。ACEI治疗有效且安全。
