Unexpectedly high prevalence of posttransplant anemia in pediatric and young adult renal transplant recipients

Yorgin, Peter D.; Belson, Amir; Sanchez, Jaime; Uzri, A.; Sarwal, Minnie M.; Blöch, D.; Oehlert, John; Salvatierra, Oscar; Alexander, Steven R.

doi:10.1053/ajkd.2002.36910

Cited by 75 publications

(80 citation statements)

References 44 publications

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“…The strongest predictor of this complication was anemia at 3 mo after (12,13,16). The significant association that was observed between 12-mo PTA and requirement for and duration of pretransplantation dialysis was not maintained after adjustment for potential confounders in the logistic regression model.…”

Section: Discussionmentioning

confidence: 88%

“…PTA has not been defined uniformly in terms of time frame or hemoglobin level after transplantation. Some authors have suggested distinguishing early from late PTA, with the cutoff between the two periods being the 6-mo posttransplantation time point (10,(15)(16)(17)(18). Several risk factors have been associated with PTA, including chronic allograft dysfunction, antiproliferative immunosuppression (e.g., mycophenolate mofetil [MMF], sirolimus), chronic iron deficiency, and renin-angiotensin system blocking therapies (angiotensin-converting enzyme inhibitors [ACEI] and angiotensin II type 1 receptor blockers [ARB]) (10,13,18,19).…”

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confidence: 99%

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Posttransplantation Anemia at 12 Months in Kidney Recipients Treated with Mycophenolate Mofetil

Imoagene-Oyedeji¹,

Rosas²,

Doyle³

et al. 2006

Journal of the American Society of Nephrology

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Although posttransplantation anemia (PTA) is common in the mycophenolate mofetil era, its impact on patient survival is unknown. This retrospective cohort study characterized factors that are associated with PTA 12 mo after transplantation in mycophenolate mofetil-treated kidney recipients and explored whether 12-mo PTA affects outcomes. The records of 626 kidney recipients were examined for presence of anemia (hemoglobin <12 g/dl). Multivariate regression models, fit with covariates that had unadjusted relationships, investigated both risk factors for 12-mo PTA and whether 12-mo PTA contributes to mortality. Anemia prevalence was 72, 40, and 20.3% at 1, 3, and 12 mo, respectively. By multivariate logistic regression, anemia at 3 mo (odds ratio [OR] 10.0; 95% confidence interval [CI] 5.3 to 17.1; P ‫؍‬ 0.0001), donor age (OR 1.0; 95% CI 1.1 to 1.3; P ‫؍‬ 0.005), and 3-mo creatinine (OR 2.0; 95% CI 1.2 to 3.3; P ‫؍‬ 0.044) were associated with 12-mo PTA. The PTA cohort had inferior patient survival (P ‫؍‬ 0.02, log rank) and a higher proportion of cardiovascular deaths (6.3 versus 2.2%; P ‫؍‬ 0.017) than nonanemic patients. By Cox regression, 12-mo PTA (hazard ratio [HR] 3.0; 95% CI 1.3 to 6.7; P ‫؍‬ 0.009), 12-mo creatinine (HR 1.3; 95% CI 1.1 to 1.4; P ‫؍‬ 0.008), age at transplantation (HR 1.1; 95% CI 1.1 to 1.2; P ‫؍‬ 0.004), and hepatitis C seropositivity (HR 2.8; 95% CI 1.1 to 7.0; P ‫؍‬ 0.03) were associated with mortality. There was no interaction between 12-mo PTA and serum creatinine. In conclusion, 12-mo PTA is associated with an increased risk for patient death. The presence of anemia 3 mo after kidney transplantation is a major determinant of 12-mo PTA. PTA in kidney recipients therefore should be defined by its persistence or occurrence beyond the third posttransplantation month.

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Section: Discussionmentioning

confidence: 88%

mentioning

confidence: 99%

Posttransplantation Anemia at 12 Months in Kidney Recipients Treated with Mycophenolate Mofetil

Imoagene-Oyedeji¹,

Rosas²,

Doyle³

et al. 2006

Journal of the American Society of Nephrology

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“…Anemia is a common phenomenon after kidney transplantation but remains poorly understood (26)(27)(28). Commonly identified causes of anemia include allograft dysfunction, purine synthesis inhibitors (AZA and MMF), angiotensin converting enzyme inhibitors and angiotensin-II receptor antagonists.…”

Section: Discussionmentioning

confidence: 99%

Thiopurine S-Methyltransferase Genotype Predicts Azathioprine-Induced Myelotoxicity in Kidney Transplant Recipients

Formea¹,

Myers-Huentelman²,

Wu³

et al. 2004

American Journal of Transplantation

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Azathioprine (AZA) is an immunosuppressive prodrug that undergoes metabolism by thiopurine Smethyltransferase (TPMT).Eighty to ninety-five percent of low or deficient TPMT enzyme activity is genetically determined by the presence of three nonfunctional mutant alleles: TPMT * 2, TPMT * 3A and TPMT * 3C. Using TPMT as a pharmacogenetic paradigm, we explored the association between these genetic mutations and development of adverse drug effects in an ethnically diverse renal transplant population receiving azathioprine. Biochemical and clinical data were retrospectively evaluated during the first four weeks after kidney transplantation. TPMT nonfunctional mutant alleles were identified by polymerase chain reaction-based methods. Of 89 patients initially consented, 36 met inclusion criteria for this retrospective study. Five patients possessing a single TPMT nonfunctional mutant allele were identified: TPMT * 3A: n = 2 Caucasians; TPMT * 3B: n = 1 Caucasian; TPMT * 3C: n = 2 African-Americans. TPMT nonfunctional mutant alleles were associated with significant reductions in hematological indices and a significant increase in cyclosporine plasma concentrations in the first month post-transplant. TPMT genotype was an independent predictor for hemoglobin, hematocrit and red blood cell changes while mean azathioprine dose (mg/kg/day), azathioprine dose (mg/kg/day) at day 30 and cyclosporinemia at day 30 were not. Prospective application of pharmacogenetic principles may assist in optimization of immunosuppressive drug therapy and minimize drug toxicities.

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“…However, anemia may persist in renal transplant recipients with suboptimal graft function (3). It is still a common problem after solid organ transplantations (1,13,16).…”

Section: Discussionmentioning

confidence: 99%

The Prevalence and Risk Factors of Anemia in Children with Renal Transplant

Bulut¹,

Dinçel²,

Sözerei³

et al. 2014

Turkish J Pediatr Dis

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Objective: Anemia is commonly observed during the follow-ups of patients with renal transplantation. There is not enough information on anemia observed in children with renal transplantation. The aim of this study was to evaluate the prevalence and risk factors of anemia in children with renal transplantation on the short and long-term posttransplantation period. Material and Methods:This study was performed in children who underwent renal transplant at Ege University. Anemia was defi ned as having a value less than 2 Standard Deviation for hematocrit levels according to age. Results:In the early post-transplant period, the incidence of anemia was found as 18%. Late post transplant anemia rate was detected as 27.5% at 60 months. The incidence of anemia was 18.4%, 23.3%, 23% and 27.5%, at 24, 36, 48 and 60 months after transplantation, respectively. Anemia was detected at least once in 71 (67.6%) patients at any point of the follow-up period. There was no correlation between Angiotensin Converting Enzyme inhibitor therapy and anemia at any post-transplant time. Donor type and donor age were not signifi cantly associated with late anemia. On the other hand, late anemia was signifi cantly associated with a history of rejection. Conclusion:Low estimated Glomerular Filtration Rate, longer duration of post-transplantation and rejection attacks are the risk factors for anemia in pediatric renal transplant recipients.Key Words: Anemia, Children, Renal transplantation ÖZET Amaç: Renal transplantlı hastaların takibinde anemi yaygın görülmektedir. Renal transplantlı çocuklarda görülen anemi hakkında yeterli bilgi bulunmamaktadır. Bu çalışmanın amacı; transplantasyon sonrası çocuklarda kısa ve uzun dönem-de ortaya çıkan aneminin risk faktörlerini ve prevalansını değerlendirmektir. Gereç ve Yöntemler:Bu çalışma, Ege Üniversitesi'ndeki böbrek nakilli çocuklarda yapılmıştır. Hematokrit düzeyinin yaşa göre 2 standart deviasyon altında olması anemi olarak tanımlanmıştır. Bulgular:Erken post transplant dönemde anemi insidansı %18 bulundu. Geç post transplant dönemde ortalama olarak 60 ayda %27.5 oranda anemi saptandı. Anemi insidansı post transplant 24.36,48 ve 60. aylarda sırasıyla %18.4, %23.3, %23 ve %27.5 bulundu. Takip süresince herhangi bir zamanda 71 (%67.6) hastada en az bir kez anemi tespit edildi. Transplantasyon sonrası herhangi bir dönemde kullanılan ACE inhibitörü ile anemi arasında ilişki saptanmadı. Donör tipi ve yaşı ile geç anemi arasında anlamlı bir ilişki bulunmadı. Diğer yandan, geç dönem anemi rejeksiyon öyküsüyle anlamlı ilişkili bulundu. Sonuç:Renal transplant alıcısı olan çocuklarda tahmini glomerül fi ltrasyon hızının düşüklüğü, transplantasyon sonrası sürenin uzunluğu ve rejeksiyon atağı anemi için risk faktörleridir.

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Unexpectedly high prevalence of posttransplant anemia in pediatric and young adult renal transplant recipients

Cited by 75 publications

References 44 publications

Posttransplantation Anemia at 12 Months in Kidney Recipients Treated with Mycophenolate Mofetil

Posttransplantation Anemia at 12 Months in Kidney Recipients Treated with Mycophenolate Mofetil

Thiopurine S-Methyltransferase Genotype Predicts Azathioprine-Induced Myelotoxicity in Kidney Transplant Recipients

The Prevalence and Risk Factors of Anemia in Children with Renal Transplant

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