Posttransplantation anemia in kidney transplant recipients

Abstract

We sought to assess the frequency and predictors of early and late posttransplantation anemia (PTA). In addition, we aimed to assess the outcomes of patients with anemia and to assess the impact of anemia on mortality, graft function, and graft failure.Patients who underwent kidney transplantation in a single center during a 4-year period were included. Predictors associated with the development of anemia at 6 months (early PTA) or 2 years (late PTA) were evaluated in a univariate and multivariate analyses. The effects of anemia and other variables on mortality and graft function were assessed.A total of 266 kidney transplant recipients were included. The prevalence of PTA at 6 months (early PTA) was 51.3% and at 2 years (late PTA) was 36.6%. Female sex was significantly associated with early PTA. Patients with early PTA proceeded to late PTA. Patients with both early and late PTA had a higher mortality rate at 4 years compared to patients without anemia. On multivariable analysis, lower Hb at 2 years posttransplantation (hazard ratio [HR] 0.716, 95% confidence intervals [CI] 0.541–0.948, for every increment of 1 g/dL) was significantly associated with mortality. Patients with late PTA suffered a decline in eGFR compared to patients without anemia (P = .026). Furthermore, a lower Hb at 2 years posttransplantation was also associated with graft failure (HR 0.775, 95% CI 0.619–0.969, for every increment of 1 g/dL).Post-transplantation anemia is significantly associated with late mortality, with a decline in graft function and with an increased incidence of graft failure.

Post renal transplant anemia: severity, causes and their association with graft and patient survival

“…In our study, anemia was diagnosed in 36% of the cohort, in agreement with previous studies which showed a late PTA prevalence of 20–40% [1–6, 23, 27, 37, 38, 42, 44].…”

“…PTA has previously been shown to be associated with the composite outcome of all-cause mortality and graft loss [6, 17, 18, 27, 37–39], as well as the separate components: death-censored graft survival [4, 19, 20] and all-cause mortality [6, 15–18]. However, the association between PTA and increased mortality is inconsistent, as several studies failed to show association with all-cause mortality, despite an association with graft loss [4, 19, 40–43].…”

“…Post-Transplant anemia (PTA) is common among kidney-transplant patients, as different studies report a prevalence of 20–51% at various time points after transplantation [1–6].…”

“…PTA has been shown to be negatively associated with long-term outcomes: higher rates of all-cause mortality [6, 15–18], graft failure [4, 19, 20], congestive heart failure [21] and a decline in estimated glomerular filtration rate (eGFR) [6, 13]. Surprisingly, severity level was not thoroughly studied, and only one of the above studies classified patients by hemoglobin levels [19].…”

Burden of Anemia in Chronic Kidney Disease: Beyond Erythropoietin

“…Anemia prevalence decreases following kidney transplant, from 71% pre-transplant to 51% at 6 months and 37% at 2 years post-transplant. However, post-transplant anemia does occur [ 78 ]. In kidney transplant recipients, lower Hb is a predictor for a return to dialysis, graft failure, subsequent kidney transplant, reduced LV mass index, or death [ 78 , 79 ].…”