B. Moulin et al., SERUM ERYTHROPOIETIN AND RETICULOCYTE MATURITY INDEX AFTER RENAL-TRANSPLANTATION - A PROSPECTIVE LONGITUDINAL-STUDY, Nephron, 69(3), 1995, pp. 259-266
Improvement in erythropoiesis following renal transplantation (RT) was
assessed in 74 consecutive patients by serial measurements of serum e
rythropoietin (EPO), hematocrit, absolute reticulocyte count (ARC) and
serum creatinine during the first month after RT. The reticulocyte ma
turity index (RMI) which provides an objective measure of red-cell mat
urity was assessed in 31 patients by flow cytometry using thiazole ora
nge. In group I (n = 39) with immediate graft function, EPO levels inc
reased rapidly from day 2 and remained elevated at the plateau between
two and three times the upper limit of normal during the first 2 mont
hs. In group II (n = 29) with delayed graft function, EPO levels incre
ased gradually from day 10 when renal function improved significantly.
No particular significant biphasic pattern of secretion was detected
in group I or II. In both groups, hematocrit rose to over 35% approxim
ately 3 months after RT. In a third group (n = 6) with immediate posto
perative acute blood loss and severe anemia, a hematocrit fall was fol
lowed by a steep increase in EPO levels with a negative correlation be
tween hematocrit and EPO levels during the first 4 days. During acute
rejection, EPO diminished significantly by more than 50% either on the
day of diagnosis or on the following days in 8 patients. RMI increase
d by 25% over the pretransplantation values by 7 days on average befor
e the ARC rose. Thus the RMI seems to be an early sensitive predictor
of erythropoiesis after RT. EPO response after RT depends on graft fun
ction, and the early transient increase in EPO observed in patients wi
th acute blood loss may explain the apparent biphasic response previou
sly reported.