Posttransplantation Anemia

Yabu, Julie M.; Winkelmayer, Wolfgang C.

doi:10.2215/cjn.01190211

Cited by 60 publications

(53 citation statements)

References 71 publications

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“…No décimo mês pós-transplante e quatro semanas após IVIG, o Anemia pós-transplante por Parvovírus B19 transplante renal, há dados suficientes pra recomendar a investigação em pacientes transplantados com anemia resistente a eritropoetina nos quais outras causas foram excluídas. 3,7,15 Pacientes de mais alto risco para esta infecção incluem receptores de transplante de órgãos que estão gestantes, aqueles submetidos a protocolos de indução com anticorpos, com história de tratamento para rejeição aguda, ou que apresentaram infecção viral oportunística, como CMV ou vírus Epstein-Barr. Os períodos de maior risco de infecção por PV B19 são aqueles associados a maiores níveis de imunossupressão, como o pós-transplante imediato e após tratamento de episódios de rejeição aguda.…”

Section: Discussionunclassified

“…16 O tratamento proposto atualmente se baseia no uso de IVIG em associação com a redução da imunossupressão. 3,7,15 Devido à alta prevalência de Ig G contra PV B19 na população adulta, as preparações de IVIG são a melhor fonte destes anticorpos.…”

Section: Discussionunclassified

“…Até 8,5% destes apresentam níveis de hemoglobina inferiores a 11 mg/dL e 10 mg/dL, respectivamente, para homens e mulheres, com necessidade frequente de reposição de eritropoetina e de hemotransfusões. [1][2][3] A extensa lista de fatores de risco para o desenvolvimento de anemia após o transplante renal inclui deficiência de eritropoetina por disfunção do enxerto, deficiência pré-existente de ferro, mielotoxicidade por drogas, como inibidores da enzima de conversão da angiotensina (IECA), bloqueadores de receptor da angiotensina (BRA), azatioprina e micofenolato mofetil, doadores com idade superior a 60 anos, doença renal crônica (DRC) de base, sendo a doença renal policística do adulto (DRPA) um fator protetor, microangiopatia trombótica e presença de infecções ativas, notadamente infecções virais, como a parvovirose B19 (PV B19). 1,2,[4][5][6][7][8] A infecção pelo PV B19 é causa bem descrita de anemia nos pacientes no pós-transplante renal, podendo levar à aplasia pura de série vermelha (APSV) devido ao tropismo do vírus pelos progenitores eritroides presentes na medula óssea.…”

Section: Introductionunclassified

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Posttransplant chronic anemia: parvovirus B19

Vincens¹,

Carminatti²,

Franco³

et al. 2012

Jornal Brasileiro De Nefrologia

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A anemia é frequente em pacientes após o transplante renal (TxR) e sua prevalência varia conforme o tempo pós-transplante e os critérios diagnós-ticos empregados. A infecção pelo Parvovírus B19 (PV B19) é causa subdiagnosticada de anemia nesta população. Para ilustrar a epidemiologia e espectro clínico, apresentamos caso de PV B19 que evoluiu com aplasia pura de série vermelha (APSV), ressaltando as dificuldades do diagnóstico e tratamento. O emprego da detecção do DNA viral pela reação em cadeia da polimerase e do diagnóstico das alterações da morfologia da medula óssea são particularmente úteis para o diagnóstico no paciente transplantado imunossuprimido que falha na produção da resposta humoral contra o PV B19.Anemia is frequent in kidney transplant patients, and its prevalence varies according to posttransplant time and the adopted diagnostic criteria. Parvovirus B19 (PV B19) infection is an underdiagnosed cause of anemia in this particular population. To illustrate epidemiologic and clinical data regarding it, we present a case of PV B19 infection complicated by pure red cell aplasia (PRCA), pointing out the pitfalls we encountered in diagnosis and treatment. The use of viral DNA detection by polymerase chain reaction (PCR), and correct interpretation of morphological features of bone marrow histology are particularly important for the diagnosis of this condition in kidney transplant patients, who fail to develop a proper humoral response against PV B19, thus importantly decreasing the sensitivity of serological methods in this setting. Anemia crônica no pós-transplante renal: parvovirose B19Posttransplant chronic anemia: parvovirus B19 ResumoPalavras-chave: anemia, aplasia pura de série vermelha, imunoglobulinas intravenosas, parvovirus B19 humano, transplante de rim. AbstRAct

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Section: Discussionunclassified

Section: Introductionunclassified

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Posttransplant chronic anemia: parvovirus B19

Vincens¹,

Carminatti²,

Franco³

et al. 2012

Jornal Brasileiro De Nefrologia

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“…Chronic kidney disease (CKD) blunts erythropoietin production [2], a proanemic effect that is compounded by other factors such as accelerated erythrocyte destruction and widespread use of concomitant medication such as ACE inhibitors and ARBs [3]. Following transplantation, the prevalence of anemia declines sharply as renal function is restored but low hemoglobin (Hb) levels persist in a worryingly large proportion of cases due to multiple factors such as suboptimal renal function, cardiovascular medication, and certain immunosuppressive therapies [4, 5].…”

Section: Introductionmentioning

confidence: 99%

“…This low intervention rate may partly reflect missed diagnoses and safety concerns about ESA therapy to target high Hb levels [21–24], but also the relative paucity of robust trials of ESA therapy in kidney transplantation. Findings from nontransplant populations cannot necessarily be extrapolated to kidney transplantation since the mechanisms underlying anemia and epoetin resistance may differ [3]. The available evidence in transplant patients, however, indicates that ESA therapy is effective in increasing Hb levels, based on data from two small randomized trials undertaken in the early posttransplant period [25, 26], a nonrandomized prospective multicenter study [27], an observational trial [28], and retrospective analyses [29, 30].…”

Section: Introductionmentioning

confidence: 99%

Anemia Control in Kidney Transplant Recipients Using Once-Monthly Continuous Erythropoietin Receptor Activator: A Prospective, Observational Study

Budde

Rath

Kliem³

2014

Journal of Transplantation

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In a multicenter, prospective, observational study of 279 kidney transplant recipients with anemia, the efficacy and safety of once-monthly continuous erythropoietin receptor activator (C.E.R.A.) were assessed to a maximum of 15 months. The main efficacy variable was the proportion of patients achieving a hemoglobin level of 11-12 g/dL at each of visits between months 7 and 9. At study entry, 224 patients (80.3%) were receiving erythropoiesis stimulating agent (ESA) therapy including darbepoetin alfa (98), epoetin beta (61), and C.E.R.A. (45). The mean (SD) time between C.E.R.A. applications was 34.0 (11.9) days. Among 193 patients for whom efficacy data were available, mean (SD) hemoglobin was 11.1 (0.99) g/dL at study entry, 11.5 (1.1) g/dL at month 7, 11.6 (1.3) g/dL at month 9, and 11.4 (1.1) g/dL at month 15. During months 7–9, 20.7% of patients had all hemoglobin values within the range 11-12 g/dL and 64.8% were within 10–13 g/dL. Seven patients (2.5%) discontinued C.E.R.A. due to adverse events or serious adverse events. In this observational trial under real-life conditions, once-monthly C.E.R.A. therapy achieved stable hemoglobin levels in stable kidney transplant recipients with good tolerability, and with no requirement for any dose change in 43% of patients.

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Pregnancy care in solid organ transplant recipients

Kallapur

Jang

Yin

et al. 2021

Intl J Gynecology & Obste

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Recipients of solid organ transplants who become pregnant represent an obstetrically high-risk population. Preconception planning and effective contraception tailored to the individual patient are critical in this group. Planned pregnancies improve both maternal and neonatal outcomes and provide a window of opportunity to mitigate risk and improve lifelong health. Optimal management of these pregnancies is not well defined. Common pregnancy complications after transplantation include hypertension, preterm birth, infection, and metabolic disease. Multidisciplinary preconception and prepartum management, and counseling decrease complications and benefit the maternal-neonatal dyad.

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Posttransplantation Anemia

Cited by 60 publications

References 71 publications

Posttransplant chronic anemia: parvovirus B19

Posttransplant chronic anemia: parvovirus B19

Anemia Control in Kidney Transplant Recipients Using Once-Monthly Continuous Erythropoietin Receptor Activator: A Prospective, Observational Study

Pregnancy care in solid organ transplant recipients

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