A Retrospective Assessment of Pre‐Treatment Variables on the Response to Darbepoetin Alfa After Renal Transplantation

Abstract

This retrospective review assesses the efficacy of darbepoetin alfa for treating anemia after renal transplantation. Patients were evaluated over a 12-week period, and efficacy was based on achieving hemoglobin >12 g/dL. Thirty-six patients were analyzed (53% male, 53% cadaveric allografts, median age 42.5 years). Baseline creatinine clearance ranged from ∼15 to >100 mL/min. Most patients initiated darbepoetin alfa <3 months (50%) or >12 months (44%) after transplantation, 19% were previously receiving recombinant human erythropoietin (rHuEPO), and 47% were on concomitant ACE inhibitors. The majority of patients received either tacrolimus-(53%) or cyclosporine-(44%) based immunosuppression. Overall, 29 (81%) patients achieved the hemoglobin target with a mean time to response of 4.4 weeks. Neither the time to anemia onset, previous rHuEPO therapy, concomitant ACE inhibitor, allograft source, immunosuppressive regimen, nor degree of renal function affected the proportion of patients achieving the hemoglobin target, time to response or darbepoetin alfa dose requirement. Patients with anemia >12 months post-transplantation or on concomitant ACE inhibitors required a significantly longer duration of therapy. No adverse events associated with darbepoetin alfa therapy were detected. These results demonstrate that darbepoetin alfa is a safe and effective treatment for anemia in renal transplant recipients.

Posttransplantation Anemia at 12 Months in Kidney Recipients Treated with Mycophenolate Mofetil

“…Because recombinant human erythropoietin was not used routinely in our patient cohort during this period of observation, it is unknown what impact this therapy might have had on patient outcomes. Certainly, recent studies have shown the efficacy and the safety of recombinant human erythropoietin in the correction of anemia in kidney recipients (32)(33)(34)(35)(36). There are several limitations to our study.…”

Systemic and Nonrenal Adverse Effects Occurring in Renal Transplant Patients Treated with mTOR Inhibitors

“…The success of EPO-stimulating agents (ESAs) in increasing hemoglobin levels may be related to the cause of anemia and clinical reasons for anemia correction [38, 39]. The data suggest that ESA treatment soon after transplantation shortens the time of hemoglobin correction [60, 61]. Then, iron repletion is important, as even patients with suboptimal erythropoietin levels can correct anemia with adequate iron.…”

Increased adenosine triphosphate production by peripheral blood CD4+ cells in patients with hematologic malignancies treated with stem cell mobilization agents

“…In that setting, mobilization of PHA-responsive myeloid precursors occurred in the aftermath of thymoglobulin-induced lymphocyte depletion, via a compensatory mechanism. Notably, treatment with Darbepoetin, an erythropoietin analog that stimulates the mobilization and differentiation of hematopoietic precursors [32], further enhanced ATP activity in lymphocyte-depleted patients [30]. It is most likely that the residual ATP activity measured in the present study upon the depletion of CD3 ϩ T cells from the blood of patients treated with G-CSF/GM-CSF is also due to newly mobilized myeloid cells, which have the capacity to respond to PHA stimulation.…”