What is your approach to post kidney transplant erythrocytosis for a asymptomatic patient already on ACEi but with Hb consistently >18?

In an asymptomatic kidney transplant recipient with persistent post-transplant erythrocytosis (Hct >=55%) despite ACE inhibitor therapy, what is your next step?

• Optimize ACE inhibitor dosing or switch to an ARB
• Initiate therapeutic phlebotomy to target Hct < 50-55%
• Initiate therapeutic phlebotomy to target Hct < 45%
• Continue current therapy and observe
• Other