Chronic Anemia in Heart Transplant Patients: Prevalence, Risk Factors, and Prognostic Significance

Abstract

Introduction and objectives. Data on chronic anemia following heart transplantation (HT) are scarce and contradictory. Our aims were to determine the prevalence of chronic anemia after HT, to identify predisposing factors for the condition at 12 months, and to evaluate its influence on mediumterm and long-term survival. Methods. Retrospective analysis of patients who underwent HT between 1991 and 2005 (n=457). Chronic anemia was defined as a hemoglobin level <12 g/dL. Results. The prevalence of post-HT chronic anemia was 75.5% at 1 month, 31% at 12 months, and 26.2% at 120 months. The condition was significantly more prevalent among women than men. Predisposing factors for chronic anemia 1 year post-HT were mild-to-moderate chronic renal failure (ie, creatinine level > 1.5 mg/dL; odds ratio [OR]=2.8; 95% confidence interval [CI], 1.5-5.0), female sex (OR=6.4; 95% CI, 3.1-13.2), and immunosuppression with mycophenolate mofetil compared with azathioprine (OR=2.6; 95% CI, 1.4-4.8). The prevalence of chronic anemia 12 months after HT was independent of the donor's sex, the recipient's age, the etiology of the recipient's heart failure, diabetes mellitus, mild-to-moderate graft rejection, cytomegalovirus infection, and angiotensinconverting enzyme inhibitor treatment. The presence of chronic anemia 12 months after HT did not influence either long-term survival (mean, 11.5 years with chronic anemia vs 13.0 years without) or actuarial survival. Conclusions. Post-HT chronic anemia is common, but improves with time and treatment. Predisposing factors for the condition 1 year post-HT include chronic renal failure, female sex, and immunosuppression with mycophenolate mofetil. The presence of chronic anemia does not appear to influence long-term survival. Introducción y objetivos. La información disponible sobre anemia crónica (AC) en pacientes con trasplante cardiaco (TC) es escasa y discordante. Nuestro objetivo fue estudiar la prevalencia de AC en pacientes post-TC, factores predisponentes de AC a 12 meses y su significa-do pronóstico a medio y largo plazo. Métodos. Análisis retrospectivo de pacientes con TC entre 1991 y 2005 (n = 457). AC fue definida como hemoglobina < 12 g/dl. Resultados. La prevalencia de AC post-TC fue del 75,5% a 1 mes, el 31% a los 12 meses y el 26,2% a los 120 meses, significativamente más prevalente en mujeres que en varones. Factores predisponentes de AC a 12 meses: insuficiencia renal crónica (IRC) leve-mode-rada (creatinina > 1,5 mg/dl) (odds ratio [OR] = 2,8; intervalo de confianza [IC] del 95%, 1,5-5); sexo femenino (OR = 6,4; IC del 95%, 3,1-13,2), e inmunosupresión con micofenolato mofetilo (MMF) respecto a azatioprina (OR = 2,6; IC del 95%, 1,4-4,8). La prevalencia de AC 1 año tras el TC no se relacionó con el sexo del donante, la edad del receptor, la cardiopatía del receptor, la diabetes mellitus, el rechazo leve o moderado del injerto (= 3A), infección por citomegalovirus o tratamiento con inhibidores de la enzima de conversión de angiotensina. Tener AC a 1 año del TC no supuso diferen...

The Utility of a Specific Measure for Heart Transplant Patients: Reliability and Validity of the Kansas City Cardiomyopathy Questionnaire

“…Overall, correlations with the clinical variables were positive (the better the clinical value, the higher the HRQoL) and similar to those of previous studies (18 -21), as were correlations with seric creatinine and higher cholesterol levels. We have found an important association between the HRQoL of transplanted patients and their degree of anemia in the initial stages, as previously described by other authors (22). Furthermore, the incidence of adverse posttransplantation events (initial graft dysfunction and acute rejection) was within the limits observed in other series of heart transplantations.…”

Exercise capacity following pediatric heart transplantation: A systematic review

“…Immunosuppression regimens may contribute to impaired exercise capacity of pediatric HT recipients by inducing anemia and reducing muscle metabolism and function . Variability of immunosuppression regimens makes it is difficult to draw definitive conclusions regarding the effects of immunosuppression on exercise capacity.…”

Blood volume and hemoglobin mass in long-term heart transplant recipients with and without Anemia

“…Our anemic HTX patients had lower iron levels and transferrin saturation indicating possible mild iron deficiency although erythrocytes were normocytic and normochromic. Interestingly, this was not associated with renal function that was previously identified as a predisposing factor [ 13 , 37 ]. As a limitation, our HTX subjects showed only moderate renal impairment with five HTX patients yielding a GFR < 40 ml/min.…”

“…It seems there is a temporal dependence of the development of anemia with high prevalence postoperatively from 90% at discharge [ 37 ] to 78% six weeks after transplantation [ 38 ] and decrease in the further course when summarizing the few available studies. However, even 115 to 120 months after transplantation, anemia rates of 26% [ 37 ] to 41% [ 13 ] were reported. At a mean follow-up of 76 months after transplantation, we found a slightly lower anemia prevalence of 19%, which might have influenced the results.…”