This protocol covers secondary polycythemia in patients with a history of kidney transplantation in whom haematocrit has stayed above 0.51 for more than one month post-transplant — and in whom first-line pharmacological treatment has not achieved the target reduction.
Post-transplant erythrocytosis is a recognised complication of renal transplantation, often self-limiting, and typically arising within the first year — though it can emerge at two to four years. A haematocrit exceeding 0.51 persisting beyond one month after transplantation is the defining threshold for this clinical scenario.
First-line management involves an angiotensin-converting enzyme inhibitor (captopril or enalapril) or an angiotensin receptor blocker (losartan), which reduces haematocrit in the majority of patients. The goal of this initial line is haematocrit reduction to a nadir by three months. When that target is not reached — with erythrocytosis persisting beyond three months — a further protocol step applies.
For patients with persistent symptoms in whom prior therapy has not achieved sufficient haematocrit reduction, a targeted procedural approach may be considered, guided by a specific haematocrit goal. Full patient selection criteria, procedural details, and follow-up targets are set out in the structured protocol.
DOI: 10.1111/bjh.15647
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