Haematological changes after renal transplantation: differences between cyclosporin-A and azathioprine therapy

Cyclosporine-A-Induced Intracranial Thrombotic Complications: Systematic Review and Cases Report

This study reported two cases of intracranial thrombotic events of aplastic anemia (AA) under therapy with cyclosporine-A (CsA) and reviewed both drug-induced cerebral venous thrombosis (CVT) and CsA-related thrombotic events systematically. We searched PubMed Central (PMC) and EMBASE up to Sep 2019 for publications on drug-induced CVT and Cs-A-induced thrombotic events. Medical subject headings and Emtree headings were used with the following keywords: "cyclosporine-A" and "cerebral venous thrombosis OR cerebral vein thrombosis" and "stroke OR Brain Ischemia OR Brain Infarction OR cerebral infarction OR intracerebral hemorrhage OR intracranial hemorrhage." We found that CsA might be a significant risk factor in inducing not only CVT but also cerebral arterial thrombosis in patients with AA.

Post-renal transplant erythrocytosis: a case report

PTE is defined as hematocrit >51% or hemoglobin >17 g/dL after renal transplantation. Risk factors include native kidneys with adequate erythropoiesis pretransplant, smoking, renal artery stenosis, and cyclosporine treatment. We report the case of a 14-yr-old female kidney transplant patient, with triple therapy immunosuppression and stable graft function who developed PTE at 12 months post-transplant with hemoglobin 17.3 g/dL, hematocrit 54.2%, stable graft function, and normotensive with normal cardiac echocardiogram and erythropoietin levels. The only risk factor found was tobacco use. As she had no spontaneous improvement, enalapril treatment was started at 19 months post-transplant with a hemoglobin level of 17.5 g/dL and hematocrit 53%; by 23 months post-transplant, hemoglobin lowered to 15 g/dL and hematocrit to 44.5% and continued to be in normal range thereafter. PTE is a rare condition in childhood and can be successfully treated with enalapril.

KDIGO clinical practice guideline for the care of kidney transplant recipients

The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the monitoring, management, and treatment of kidney transplant recipients is intended to assist the practitioner caring for adults and children after kidney transplantation. The guideline development process followed an evidence-based approach, and management recommendations are based on systematic reviews of relevant treatment trials. Critical appraisal of the quality of the evidence and the strength of recommendations followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. The guideline makes recommendations for immunosuppression, graft monitoring, as well as prevention and treatment of infection, cardiovascular disease, malignancy, and other complications that are common in kidney transplant recipients, including hematological and bone disorders. Limitations of the evidence, especially on the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research.

Bilateral nephrectomy of the native kidneys reduces the incidence of arterial hypertension and erythrocytosis in kidney graft recipients treated with cyclosporin. Leuven Collaborative Group for Transplantation

Since the use of cyclosporin (CsA) the incidence of post-transplant arterial hypertension and erythrocytosis has increased sharply. In a retrospective analysis of 707 consecutive first cadaveric kidney graft recipients treated with CsA as basic immunosuppression, the effect of bilateral native nephrectomy on arterial hypertension and erythrocytosis was studied. Patient and graft survival as well as kidney function of the 264 nephrectomized patients were identical to those of the 443 non-nephrectomized patients. In the nephrectomized patients the mean number of rejections during the first year was 0.62 +/- 0.88 versus 0.78 +/- 1.02 in the non-nephrectomized patients (P = 0.0285). At 1 year after transplantation, 65.8% of the non-nephrectomized patients needed hypotensive drugs versus 45.3% of the nephrectomized patients (P < 0.0001). Notwithstanding the use of more antihypertensive drugs, diastolic blood pressure in the former group was significantly higher than in the latter group (87 +/- 25 versus 83 +/- 10 mmHg; P < 0.02). During the first year 44 (9.9%) of the non-nephrectomized patients had haemoglobin levels higher than 17 g/dl versus only six (2.3%) of the nephrectomized patients (P < 0.0001). Comparable differences were also found up to 5 years after transplantation. These findings indicate that native nephrectomy is helpful in controlling arterial hypertension and erythrocytosis.