Posttransplantation Anemia in Adult Renal Allograft Recipients: Prevalence and Predictors

Shah, Nilesh; Al-Khoury, Salam; Afzali, Behdad; Covic, Adrian; Roche, Alison; Marsh, James E.; Macdougall, Iain C.; Goldsmith, David

doi:10.1097/01.tp.0000205174.97275.b5

Cited by 106 publications

(81 citation statements)

References 24 publications

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“…In a subgroup of patients free of blood transfusion and anemia-related therapy, pretransplant Hb and ferritin level, eGFR at month 3, donor age, renal diagnosis of polycystic disease, gender, and duration of initial hospitalization were observed to be independently associated with Hb level at month 3. These results confirm and extend data from reported surveys [1,2,5,7,9,11] The observation of an independent association between pretransplant ferritin level and Hb level at month 3 underscores the role of iron deficiency in the pathogenesis of PTA [1,9,11]. Serum ferritin levels modestly but significantly declined after renal transplantation.…”

Section: Discussionsupporting

confidence: 81%

“…Prevalences of posttransplant anemia (PTA) reported in literature range between 20% and 70%. This large variability is at least partly explained by differences in diagnostic criteria and interval since transplantation [1][2][3][4][5][6][7][8][9][10][11][12]. Current research is mainly focused on anemia, persisting 3 months after transplantion, with a distinction made between early (between 3 and 6 months) and late (more than 6 months) PTA.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and determinants of anemia in the immediate postkidney transplant period

Poesen

Bammens

Claes

et al. 2011

Transplant International

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Summary At the time of renal transplantation, erythropoiesis‐stimulating agents and iron supplementation are routinely discontinued in the prospect of recovery of renal function. This recovery, however, is often delayed and suboptimal. In addition, blood loss because of frequent diagnostic phlebotomies may be substantial. Renal transplant recipients may thus be considered at high risk of anemia in the immediate post‐transplant period. We performed a single‐center observational study, including 391 recipients of a single kidney. Hemoglobin levels and parameters of iron metabolism were monitored during the immediate post‐transplant period, i.e., the first 3 months after transplantation. Hemoglobin levels decreased by 3.8 ± 1.5 g/dl to reach a nadir of 9.1 ± 1.2 g/dl at day 7. Transient severe anemia was observed in 91.3% of the patients. Donor age, gender, renal diagnosis of polycystic disease, pretransplant hemoglobin and ferritin level, estimated glomerular filtration rate at month 3, and duration of initial hospitalization were observed to be independently associated with the hemoglobin level at month 3. Transient severe anemia is an almost universal observation in incident renal transplant recipients. Poor graft function, high donor age, and low iron stores are independently associated with low hemoglobin levels at month 3.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Prevalence and determinants of anemia in the immediate postkidney transplant period

Poesen

Bammens

Claes

et al. 2011

Transplant International

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“…In the early postoperative period, anemia is the consequence of blood loss, graft failure to generate enough erythropoietin, and drugs that inhibit bone marrow erythropoiesis (3)(4)(5). Late posttransplantation (post-tx) anemia (PTA) has been attributed to renal dysfunction, immunosuppressive drugs, antiviral agents, infections, and the use of angiotensin-converting enzyme inhibitors (ACEI) (3,6). Despite few reports, the impact of PTA on patient survival, renal allograft survival, and the rate of acute rejection has not been extensively studied (7).…”

mentioning

confidence: 99%

Impact of Anemia after Renal Transplantation on Patient and Graft Survival and on Rate of Acute Rejection

Chhabra

Grafals²,

Skaro

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: The impact of posttransplantation anemia on patient survival, renal allograft survival, and rate of acute rejection is not known.Design, setting, participants, & measurements: A total of 1023 patients who underwent kidney transplantation at one center from January 1992 through June 2003 were retrospectively analyzed. Posttransplantation anemia was defined as mean hemoglobin <11 g/dl after 3 mo after transplantation. Data on demographics, pretransplantation dialysis, previous transplant history, pretransplantation hemoglobin, degree of HLA mismatch, and donor characteristics were collected. Some of the posttransplantation data that were collected in addition to the hemoglobin included delayed graft function; diabetes; hypertension; induction and maintenance of immunosuppressive regimen; posttransplantation infections; and use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, statins, aspirin, and ␤ blockers. Cox regression models were used to assess the effects of posttransplantation anemia on each outcome: Mortality, graft survival, and rate of acute rejection. Median follow-up time was 4 yr.Results: During the entire follow-up period, there were 89 (9%) deaths, 143 (14%) acute rejection episodes, and 235 (23%) kidney losses. In multivariate Cox regression models, being anemic after transplantation, after the first 90 d, was associated with increased overall mortality and increased renal allograft loss. Posttransplantation anemia was also associated with increased acute rejection rates.Conclusions: This study shows that posttransplantation anemia is associated with worse patient and graft survival and higher rates of acute rejection when compared with nonanemic renal transplant recipients.

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“…The anti-metabolite medications, including azathioprine, MMF, and mycophenolic acid, cause anemia via bone marrow suppression (8,12,21,22). A recent study investigated whether genetic factors could predict the development of mycophenolate-associated anemia (23).…”

Section: Medicationsmentioning

confidence: 99%