Recombinant Human Erythropoietin Treatment of Anemia in Renal Transplant Patients

Abstract

The rHuEpo effect on anemia in eight renal transplant patients (group A) with severe anemia (Hb 6.0-7.5 g/dL) and chronic graft failure (CGF) (sCr 281-794 mumol/L) was compared to the rHuEpo effect on anemia in predialysis (20 patients-group B) and hemodialysis patients (17 patients-group C) in order to examine the rHuEpo effect on anemia and graft failure progression, and to find out whether the response to therapy in these three patient groups differed. Although renal function impairment was similar in patients from group A and B, anemia was more severe in patients from group A. Serum immunoreactive erythropoietin levels were within normal limits for nonanemic persons, that is, inadequate for the level of anemia in all patients before therapy. Maintenance immunosuppression given after renal transplantation consisted of cyclosporine, azathioprine, and prednisone in standard doses. The startig rHuEpo dose of 150 U/kg/wk increased by 25 U/kg if the target Hb of 10.0 g/dL was not achieved at the end of a 4-week period. When target Hb was achieved, the rHuEpo dose was regularly adjusted to maintain Hb of 10.0 g/dL. Most patients from group A and group C were polytransfused before rHuEpo therapy and consequently with iron overload so that only some patients from these groups and all predialysis patients needed iron supplementation given orally. Anemia improved in all patients with 2 to 10 weeks of treatment. Mean rHuEpo doses for the first 2 months were similar in three studied groups, but the patients with the lowest initial hemoglobin values responded better to rHuEpo therapy. The rate of Hb increase during the initial phase of therapy was significantly higher in patients from group A and B comparing to patients from group C, indicating the importance of residual renal function for rHuEpo effect on anemia. Progression of CGF expressed by the slope of l/sCr vs. time did not change in either patients from group A or in predialysis patients. It could be concluded that rHuEpo therapy improved anemia in transplant patients as in predialysis and hemodialysis patients. Anemia improvement by rHuEpo did not accelerate the progression of graft function.

A Retrospective Assessment of Pre‐Treatment Variables on the Response to Darbepoetin Alfa After Renal Transplantation

“…The effective dose and time to response in this renal transplant population were in accordance with the prescribing information included in the Aranesp ® package insert for patients with CKD (0.45 μg/kg/week, with approximately 4 weeks to response) (18). These data support previously published work suggesting that darbepoetin alfa may be equally effective in treating post‐transplantation anemia as anemia of CKD (22), but more extensive studies in a larger patient population are still needed. In addition, the results of this study support the findings of a slightly smaller retrospective review of data from 24 anemic renal transplant recipients demonstrating that subcutaneous darbepoetin alfa administered once weekly resulted in a significant rise in Hb levels (17).…”

Prevalence and Management of Anemia in Renal Transplant Recipients: A European Survey

“…Will epoetin therapy in transplant recipients be as effective as in nontransplanted patients? Several reports of small groups of patients have shown that epoetin is as effective in renal transplant recipients as in dialysis patients (20–22). However, epoetin resistance in transplant recipients, probably related to the inflammatory syndrome of chronic rejection, has been reported as well (23).…”

Anemia in children after transplantation: etiology and the effect of immunosuppressive therapy on erythropoiesis

“…Doses of 50–150 units/kg/wk of rhEPO were administered subcutaneously to iron‐rich patients with good response. The main side‐effects reported were significant increase in the requirement of antihypertensive medications (7, 16–18). In adult renal transplant populations with declining renal function, studies have been performed which report that rhEPO effectively and safely increased hemoglobin levels (16, 17).…”

“…The main side‐effects reported were significant increase in the requirement of antihypertensive medications (7, 16–18). In adult renal transplant populations with declining renal function, studies have been performed which report that rhEPO effectively and safely increased hemoglobin levels (16, 17). Muirhead reported improvement in Quality of Life scores with the correction of anemia in transplant recipients (19).…”