Atherosclerotic renal artery stenosis in patients starting dialysis: an emperor with no clothes.

Sir, European guidelines for long-term management of the transplant patients were published in your journal in 2002. Section IV.9.3 of these guidelines discusses post-transplant erythrocytosis [1]. It refers to the paper of Wickre et al. [2] and claims that: ‘One study in 53 polycythaemic transplant patients failed to find any increased incidence of thromboembolic events’. In fact, upon reviewing the original article of Wickre et al., one finds that the results of this study and the conclusion of the authors are exactly the opposite of the above-mentioned statement. They studied a series of 53 renal transplant patients with erythrocytosis, and compared them with a matched control group of 49 recipients. Over a followup period of 3.5 years, 11 thromboembolic events occurred in 10 of the 53 erythrocytosis patients, but none in the control group (P < 0.001). They then concluded that the incidence of thromboembolic events is significantly increased in transplant recipients with erythrocytosis. This finding was later confirmed by other studies [3]. I believe that this petite erreurmerits correction even 1 year after publication, because it appeared in the ‘guidelines’, which are often read and used for a long time bymany readers.