Assessment of erythropoiesis following renal transplantation.
Ten patients, who received cadaveric kidneys, were followed for 24 wk with serial measurements of serum erythropoietin (S-Epo), transferrin receptor (S-TfR) and iron variables. The mean pretransplant creatinine clearance was 8.2 (range 0-22) ml/min and the mean haemoglobin (Hb) level was 99 +/- 18.6 (range 66-124) g/l. Nine patients demonstrated a gradual increase in S-Epo levels, which reached a peak, and was accompanied by a parallel increase in S-TfR levels with a median lag period of 3 wk between both peaks. Hb correction followed the S-TfR peak after a second lag period (median 7 wk). Elevated S-Epo and S-TfR did not result in correction of anaemia in 1 patient due to impaired graft function. Within 4 months, S-Epo levels reached the normal range while TfR levels were higher than normal. Follow-up of iron status demonstrated the development of iron deficiency in 5 patients, which was corrected spontaneously. Improvement in erythropoiesis after renal transplantation seems to occur by means of expansion of the erythroid marrow, as detected by increasing S-TfR levels, subsequent to a S-Epo peak. This expansion precedes Hb normalization. A nonuraemic environment is probably a prerequisite for the correction of anaemia but not for the increase in S-Epo or S-TfR levels. Iron deficiency may occur after transplantation due to an increase in iron utilization.
Beshara
S
S
Department of Internal Medicine, University Hospital, Uppsala, Sweden.
Birgegård
G
G
Goch
J
J
Wahlberg
J
J
Wikström
B
B
Danielson
B G
BG
D000328:Adult; D000740:Anemia / Q000097:blood* / Q000628:therapy; D004920:Erythropoiesis; D004921:Erythropoietin / Q000097:blood; D005260:Female; D006085:Graft Survival; D006801:Humans; D007501:Iron / Q000097:blood; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011990:Receptors, Transferrin / Q000097:blood; D014184:Transplantation, Homologous
D011990:Receptors, Transferrin; D004921:Erythropoietin; D007501:Iron