Erythrocytosis in renal transplant recipients: A single-center experience

Background: Posttransplant erythrocytosis (PTE) is defined as persistently elevated hemoglobin (Hb) >17 g/dl and or PCV >51% in renal transplant recipients. The incidence of PTE varies from 8% to 22%, with occasional life-threating thromboembolic complications. Our aim was to study the prevalence, risk factors, course, and complications of PTE. Materials and Methods: We conducted a cross-sectional descriptive study in 327 renal transplant recipients. Patients with Hb >17 g/dl were considered as PTE group, and others were considered as non-PTE group. The pattern of Hb, serum creatinine, mean arterial pressure (MAP) change, and requirement of anti-hypertensive medications was noted. Complications and their management were noted. Results: PTE was diagnosed in 51 (15.5%) patients with the median time of onset at 8 (95% confidence interval: 6–10) months after transplantation. During PTE, the mean highest documented Hb was 18.68 ± 0.73 g/dl. Mean Hb change had significant positive (r = 0.8493; P = 0.0156) correlation with mean MAP change. The dose of antihypertensive medications was increased more within 6 months of PTE diagnosis and decreased thereafter significantly. Thrombotic complications were observed in 5 (10.6%) patients. PTE was treated with enalapril in 35 (72.5%) patients and combination with phlebotomy in 11 (21.6%). Around 30 (58.8%) patients continued enalapril therapy to maintain the Hb. Conclusion: PTE was observed in 15.5% of renal allograft recipients. Hb change was temporally related to blood pressure in PTE patients. Both erythrocytosis and hypertension responded well to angiotensin-converting enzyme inhibitor.