AUTHOR=Jefferies Reece , Puttagunta Harish , Krishnan Anoushka , Irish Ashley , Swaminathan Ramyasuda , Olynyk John K. 

TITLE=mTOR Inhibitors Induce Erythropoietin Resistance in Renal Transplant Recipients

JOURNAL=Frontiers in Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.722058

DOI=10.3389/fmed.2022.722058

ISSN=2296-858X

ABSTRACT=<sec><title>Aim</title><p>To elucidate the role of mTOR inhibitors on iron, hepcidin and erythropoietin-mediated regulation of hemopoiesis in stable renal transplant recipients (RTR).</p></sec><sec><title>Background</title><p>Impaired hemopoiesis is common following renal transplantation managed using mTOR inhibitors. The mechanisms responsible are uncertain but include direct effects on iron, hepcidin or erythropoietin-mediated hemopoiesis.</p></sec><sec><title>Methods</title><p>We conducted a single center prospective case-control study of 26 adult RTR with stable allograft function. RTR received stable mTOR dosing (cases, 11/26 [42%]) or stable tacrolimus dosing (controls, 15/26 [58%]). Baseline demographics, full blood count, renal function, iron studies, hepcidin-25, Interleukin-6 (IL-6) and erythropoietin (EPO) levels were determined.</p></sec><sec><title>Results</title><p>There were no differences in age, gender or allograft function. Mean daily sirolimus dose for cases was 1.72 mg, with mean trough level of 8.46 ng/mL. Mean daily tacrolimus dose for controls was 4.3 mg, with mean trough level of 5.8 ng/mL. There were no differences in mean hemoglobin (143 vs. 147 g/L; <italic>p</italic> = 0.59), MCV (88 vs. 90 fL; <italic>p</italic> = 0.35), serum ferritin (150 vs. 85.7 μg/L; <italic>p</italic> = 0.06), transferrin saturation (26 vs. 23.3%; <italic>p</italic> = 0.46), IL-6 (11 vs. 7.02 pg/ml; <italic>p</italic> = 0.14) or hepcidin-25 (3.62 vs. 3.26 nM; <italic>p</italic> = 0.76) between the groups. EPO levels were significantly higher in the group receiving mTOR therapy (16.8 vs. 8.49 IU/L; <italic>p</italic> = 0.028). On logistic regression analysis EPO level was the only variable that had a significant impact providing an odds ratio of 0.84 (95%CI 0.66–0.98). The area under the receiver operator characteristic curve (ROC) for the analysis was 0.77 (95%CI 0.54–0.94) with <italic>p</italic> = 0.04.</p><p><bold>Conclusion:</bold> Higher levels of EPO in the absence of deranged iron biochemistry or hepcidin-25 levels suggest that EPO resistance rather than impaired iron metabolism may contribute to the impaired hemopoiesis previously demonstrated in RTR on mTOR therapy.</p></sec>