Anemia in children following renal transplantation—results from the ESPN/ERA-EDTA Registry

Krischock, Leah; Stralen, Karlijn J. van; Verrina, Enrico; Tizard, E. Jane; Bonthuis, Marjolein; Reusz, György; Hussain, Farida; Jankauskienė, Augustina; Novljan, Gregor; Spasojević-Dimitrijeva, Brankica; Podracká, Ľudmila; Zaller, Vera; Jager, Kitty J.; Schaefer, Franz

doi:10.1007/s00467-015-3201-8

Cited by 21 publications

(32 citation statements)

References 40 publications

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“…32 In a recent report on PTA in children from the ESPN/ERA-EDTA registry, patients on tacrolimus had slightly higher Hb levels than those on cyclosporin. 33 A vast majority of our patients were treated with tacrolimus; hence, we were unable to compare the prevalence of anemia between the two groups. In our study, no difference was found between the two groups.…”

Section: Epo Levels (In Patients Who Did Not Receive Epo Supplementatmentioning

confidence: 98%

Anemia and markers of erythropoiesis in pediatric kidney transplant recipients compared to children with chronic renal failure

Krause

Davidovits

Tamary

et al. 2016

Pediatric Transplantation

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PTA and anemia of CKD share a similar pathogenesis. However, PTA may be disproportionate to the reduction in the GFR. Data relating to the mechanism of PTA are scarce. We evaluated the erythropoiesis parameters in pediatric kidney recipients compared to children with CKD. A total of 100 patients (54 post-kidney TX, 46 with CKD) were enrolled in the single-center cohort study. GFR was found to be significantly lower in the CKD group (49.7±22.4 vs 72.9±28.5 mL/min/1.73 m², P<.001); anemia was significantly more common in the TX patients (52% vs 41.3%, P<.001). Iron transferrin saturation and serum ferritin levels were lower in the CKD patients. In both groups, hemoglobin Z scores significantly correlated with GFR (R=.31, P=.07). This correlation was more prominent in the CKD group (R=.43, P=.008) compared to the TX group (R=.31, P=.04). Anemia was significantly more common in the TX patients than in the CKD patients despite a better GFR. The higher prevalence of anemia in the TX group could not be explained by an iron deficiency or reduced EPO production. We speculate that immunosuppressive therapy together with resistance to EPO may play a role in the pathogenesis of post-transplantation anemia.

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Section: Epo Levels (In Patients Who Did Not Receive Epo Supplementatmentioning

confidence: 98%

Anemia and markers of erythropoiesis in pediatric kidney transplant recipients compared to children with chronic renal failure

Krause

Davidovits

Tamary

et al. 2016

Pediatric Transplantation

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“…Tacrolimus was introduced in the 1990s as an alternative to ciclosporin and is now widely used to prevent rejection after solid-organ transplantation in both adult and pediatric transplant recipients [1]. At the time of discharge after transplantation, approximately 70% of pediatric kidney transplant patients are treated with tacrolimus [2]. Tacrolimus is characterized by a narrow therapeutic index: high concentrations are associated with toxicity, malignancy, and infection, while low concentrations are associated with an increased risk of acute rejection [3, 4].…”

Section: Introductionmentioning

confidence: 99%

The potential impact of hematocrit correction on evaluation of tacrolimus target exposure in pediatric kidney transplant patients

et al. 2018

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BackgroundTacrolimus is an important immunosuppressive agent with high intra- and inter-individual pharmacokinetic variability and a narrow therapeutic index. As tacrolimus extensively accumulates in erythrocytes, hematocrit is a key factor in the interpretation of tacrolimus whole blood concentrations. However, as hematocrit values in pediatric kidney transplant patients are highly variable after kidney transplantation, translating whole blood concentration targets without taking hematocrit into consideration is theoretically incorrect. The aim of this study is to evaluate the potential impact of hematocrit correction on tacrolimus target exposure in pediatric kidney transplant patients.MethodsData were obtained from 36 pediatric kidney transplant patients. Two hundred fifty-five tacrolimus whole blood samples were available, together responsible for 36 area under the concentration-time curves (AUCs) and trough concentrations. First, hematocrit corrected concentrations were derived using a formula describing the relationship between whole blood concentrations, hematocrit, and plasma concentrations. Subsequently, target exposure was evaluated using the converted plasma target concentrations. Ultimately, differences in interpretation of target exposure were identified and evaluated.ResultsIn total, 92% of our patients had lower hematocrit (median 0.29) than the reference value of adult kidney transplant patients. A different evaluation of target exposure for either trough level, AUC, or both was defined in 42% of our patients, when applying hematocrit corrected concentrations.ConclusionA critical role for hematocrit in therapeutic drug monitoring of tacrolimus in pediatric kidney transplant patients is suggested in this study. Therefore, we believe that hematocrit correction could be a step towards improvement of tacrolimus dose individualization.Electronic supplementary materialThe online version of this article (10.1007/s00467-018-4117-x) contains supplementary material, which is available to authorized users.

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“…According to recent registry data, 60–70% of paediatric renal transplant recipients are treated with tacrolimus at the time of discharge after transplantation . Consequently, the vast majority of these children are exposed to this drug during the remainder of their childhood years towards adulthood.…”

Section: Introductionmentioning

confidence: 99%

Tacrolimus dose requirements in paediatric renal allograft recipients are characterized by a biphasic course determined by age and bone maturation

Knops

Herman

Dyck

et al. 2016

Brit J Clinical Pharma

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Children exhibit a biphasic course in tacrolimus disposition characterized by a high and stable drug clearance until a specific phase in pubertal development (TW2: 800 at age: ±14 years), followed by an important decline in relative dose requirements thereafter. Pharmacogenetic variation demonstrated an age/puberty independent effect. We suggest a critical reappraisal of current paediatric dosing algorithms for tacrolimus and drugs with a similar disposition.

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Anemia in children following renal transplantation—results from the ESPN/ERA-EDTA Registry

Cited by 21 publications

References 40 publications

Anemia and markers of erythropoiesis in pediatric kidney transplant recipients compared to children with chronic renal failure

Anemia and markers of erythropoiesis in pediatric kidney transplant recipients compared to children with chronic renal failure

The potential impact of hematocrit correction on evaluation of tacrolimus target exposure in pediatric kidney transplant patients

Tacrolimus dose requirements in paediatric renal allograft recipients are characterized by a biphasic course determined by age and bone maturation

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