Risk factors and outcomes of post‐transplant erythrocytosis among adult kidney transplant recipients: a systematic review and meta‐analysis

Abstract

Post-transplant erythrocytosis (PTE) can occur in up to 10-16% after kidney transplant (KT). However, the post-transplant outcomes of recipients with PTE in the literature were conflicting. We performed systematic review and meta-analysis of published studies to evaluate risk factors of PTE as well as outcomes of recipients who developed PTE compared with controls. A literature search was conducted evaluating all literature from existence through February 2, 2021, using MEDLINE and EMBASE. Data from each study were combined using the random-effects model. (PROS-PERO: CRD42021230377). Thirty-nine studies from July 1982 to January 2021 were included (7,099 KT recipients). The following factors were associated with PTE development: male gender (pooled RR = 1.62 [1.38, 1.91], I 2 = 39%), deceased-donor KT (pooled RR = 1.18 [1.03, 1.35], I 2 = 32%), history of smoking (pooled RR = 1.36 [1.11, 1.67], I 2 = 13%), underlying polycystic kidney disease (PKD) (pooled RR=1.56 [1.21,2.01], I 2 =44%), and pretransplant dialysis (pooled RR=1.6 [1.02, 2.51], I 2 =46%). However, PTE was not associated with outcomes of interest, including overall mortality, death-censored graft failure, and thromboembolism. Our metaanalysis demonstrates that male gender, deceased-donor KT, history of smoking, underlying PKD, and pretransplant dialysis were significantly associated with developing PTE. However, with proper management, PTE has no impact on prognosis of KT patients.

Risk Factors for Erythrocytosis in Renal Transplantation: Is Ganciclovir Therapy One of Them?

“…A study of living-donor kidney transplant recipients found that pre-transplant hypertension was significantly more frequent in the PTE group than in the non-PTE group [ 14 ]. Contrary to our study, deceased donor KT recipient status was associated with PTE in a recent meta-analysis [ 2 ].…”

“…The characteristics of patients in this study were found to be similar to the general demographic characteristics of other studies [ 10 – 12 ]. In our study, PTE was common particularly in men (90.7% male) similar to the literature [ 2 , 6 , 10 – 12 ]. It has been shown that male patients undergoing hemodialysis need less exogenous replacement of erythropoietin than female patients undergoing hemodialysis.…”

“…The etiology of PTE is unclear and is generally thought to have a multifactorial etiology [ 2 ]. Well-known risk factors include younger recipient age, young donor age, polycystic kidney disease, male sex, retention of a native kidney with adequate erythropoiesis before transplant, renal artery stenosis, and a well-functioning graft [ 2 , 3 ]. The relationships between PTE and certain immunosuppressive agents used in renal transplant are unclear [ 4 – 6 ].…”