Prevalence and incidence of erythrocytosis in liver transplant recipients
Rozita Khodashahi1,2,3, Hoda Rahimi1,4, Mohsen Aliakbarian1,5, Kambiz Akhavanrezayat1,6, Aref Abdollahzade1,4, Najmeh Kalantar7, Mohsen Seddigh Shamsi1, Monavvar Afzal Aghaee Naeein1.
1Transplant Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran; 2Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 3Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 4Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; 5Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; 6Department of Gastroenterology and Hepatology, Mashhad University of Medical Sciences, Mashhad, Iran; 7Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
Objective: This study investigated the prevalence of post-liver transplant erythrocytosis and its related factors. Erythrocytosis is a known complication after liver transplantation that can increase blood viscosity and thrombosis risk.
Methods & Materials: A total of 351 liver transplant patients between 2014 and 2022 were included, excluding those with pre-existing erythrocytosis or known causes of secondary erythrocytosis. Demographic data, transplantation etiology, the time interval from transplantation to erythrocytosis occurrence, medications, blood groups, BMI, and erythropoietin levels were analyzed.
Results: The study included 228 men (64.96%) and 123 women (35.04%), with a mean age of 45.8 ± 15.9. The most common transplantation etiologies were hepatitis B (27.06%), cryptogenic cirrhosis (24%), and autoimmune hepatitis (15.10%). Polycythemia was observed in 36 patients (10.25%) with a mean age of 36.1 ± 13.2, and erythrocytosis was observed in 9 patients (2.56%) with a mean age of 32.3 ± 11.3. The mean time interval from transplantation to polycythemia and erythrocytosis was 18.8 ± 13.2 and 26.44 ± 13.52 months, respectively. Cryptogenic cirrhosis was the predominant etiology in patients with polycythemia and erythrocytosis. There was a statistically significant correlation between prevalence of post-liver transplant erythrocytosis and etiology of liver transplantation (p<0.05). Moreover, there was a statistically significant correlation between the incidence of post-liver transplant erythrocytosis and age and BMI of recipients (p<0.05). No cardiovascular events were reported following erythrocytosis.
Conclusion: In this study, Post-liver transplant erythrocytosis occurs in 2.5% of patients approximately 2 years after transplantation. The underlying pathogenesis remains unclear, but factors such as transplantation etiology (particularly cryptogenic cirrhosis), male gender, higher pre-transplantation hemoglobin levels, lower erythropoietin levels, lower BMI, and tacrolimus use may contribute to its development.
We would like to thank the Transplant Research Center, Mashhad University of Medical Sciences, for providing supports in this manuscript. We would like to thank the Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, for their assistance in this manuscript.
[1] liver transplantation
[2] polycythemia
[3] erythrocytosis
[4] erythropoietin
