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Transplant reno‐vascular stenoses associated with early erythropoeitin use
Author(s) -
Nagarajan Suja,
Mansfield Elaine,
Hsieh Sue,
Liu Rosa,
Hsieh Frank,
Li Li,
Salvatierra Oscar,
Sarwal Minnie M
Publication year - 2007
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2007.00694.x
Subject(s) - medicine , transplantation , incidence (geometry) , immunosuppression , gastroenterology , optics , physics
Background and objectives: This report describes an unusual presentation of severe hypertension (HTN) in a subset of pediatric kidney recipients treated with a steroid avoidance pediatric renal transplantation protocol. The HTN was secondary to atypical, reno‐vascular abnormalities (RVA) of the transplanted vasculature, temporally associated with erythropoietin (EPO) use. Design, setting, participants, and measurements: To investigate the clinical significance underlying this event, a retrospective clinical study of 100 pediatric renal transplants was undertaken (50 steroid‐free and 50 matched steroid‐based controls), with peripheral blood transcriptional analysis of four RVA patients and controls. Results: Regardless of a higher observed incidence of anemia (p < 0.001) and greater overall EPO usage in the first post‐transplant year in steroid‐free patients, the incidence of new‐onset HTN at one yr was significantly less in the steroid‐free cohort (p = 0.03). Nevertheless, early EPO (first week post‐transplant) was significantly associated with the combinatory findings of new‐onset HTN (p = 0.03) and RVA (p = 0.007). Molecular mechanisms of RVA injury were investigated further by peripheral blood cDNA microarray gene expression profiling. A panel of 42 transcripts differentiated patients with RVA and HTN from three sets of matched controls, with and without HTN and EPO use, with 100% concordance (p < 0.001). The biological processes governed by these significant genes suggest a role for EPO regulation of growth factor receptor ubiquitination as a putative mechanism for renal vascular injury. Conclusion: This study cautions against the use early post‐transplant use of EPO in immunosuppression regimens with steroid minimization/avoidance, which may have an increased incidence of post‐transplant anemia.