[Treatment of post-transplant erythrocytosis: comparison of lisinopril and theophylline]

Abstract

Objective: The proposal of this study is to compare the efficacy of lisinopril and theophylline, alone or in association, on erythrocytosis in renal-transplanted patients.

Design: Prospectic, case-control study. PATIENTS/ENVIRONMENT: 15 inpatients meeting 3 main criteria: 1) ACE therapy for past erythrocytosis, 2) actual erythrocytosis, 3) symptomatic increase of haematocrit (Hct).

Intervention: The treatment has been divided into 3 consecutive phases of 30 days each: 1) lisinopril (5 mg/die), 2) theophylline (4 mg/kg/die), 3) association of 2 drugs.

Measurements: The evaluations were scheduled at the beginning and every month and consisted of renal function control, haemochromocytometric exam, serum level of folates, B12 vitamin and erythropoietin (EPO), iron level, cyclosporinemia, as well as clinic control and adverse events detection.

Results: A significative decrease of Hct values and a decrease of serum erythropoietin values was observed in patients treated with lisinopril. Patients treated with theophylline showed a significant reduction of Hct values causing a reduction of erythropoietin serum level in 8/13 patients. Lisinopril and theophylline administered in combination presented a significant decrease of Hct values, while EPO values diminished compared to basal values.

Conclusions: These data showed that lisinopril is a valid therapy for the treatment of posttransplanted patients affected by erythrocytosis and, moreover, has the benefit of antihypertensive action. Theophylline remains an alternative therapy when ACEi are contraindicated. The combination of the 2 drugs doesn't produce additional benefits.