A Systematic Review and Meta-Analysis of Posttransplant Anemia With Overall Mortality and Cardiovascular Outcomes Among Kidney Transplant Recipients

Mekraksakit, Poemlarp; Leelaviwat, Natnicha; Benjanuwattra, Juthipong; Duangkham, Samapon; Rio‐Pertuz, Gaspar Del; Kewcharoen, Jakrin; Boonpheng, Boonphiphop; Peña, Camilo; Cheungpasitporn, Wisit

doi:10.1177/15269248221145046

Cited by 8 publications

(5 citation statements)

References 49 publications

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“…Following renal transplantation, in addition to common metabolic and infectious complications, patients also encounter haematological abnormalities. 18 In our study population, the most prevalent blood-related complication was PTA. Renal transplant patients experience anemia at various periods after transplantation, and the cause of anemia differs with time.…”

Section: Discussionmentioning

confidence: 82%

Post kidney transplant hematologic abnormalities and association of post-transplant anemia with graft function

Laxminarayana,

Jayaram,

Swaminathan

et al. 2024

F1000Res

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Background Haematological abnormalities following renal transplantation are frequently observed and have a significant effect on survival and graft outcomes. The pattern of haematological abnormalities varies globally. Few studies have been conducted in Asian countries. We aimed to evaluate the patterns of haematological abnormalities in post-transplant recipients in our center during the first year after post-renal transplant and the association of post-transplant anemia with graft function. Methods This single-center retrospective study was conducted on renal transplantation recipients between 2014 and 2019. The study included all patients who received kidney transplants from live/cadaveric donors and had follow-up data collected up to 12 months after the transplant. The outcome studied was the prevalence of haematological abnormalities and the association between post-transplant anemia (PTA) and graft function in post-transplant recipients. Results A total of 106 renal transplant recipients were included in the study. The prevalence of PTA was 98% in the first week, 75% at one month, 35% at three months, 32% at six months, and 27% at 12 months. The other cytopenia cases were leukopenia (43.4%), thrombocytopenia (33.2%), and pancytopenia (15.1%). Post-transplant erythrocytosis was observed in 17.9% of patients. 18 patients with severe PTA in the first week of transplant had significant allograft dysfunction (p=0.04). Patients with and without PTA had similar graft functions at six and 12 months (p=0.50). Conclusions Haematological abnormalities are common in renal transplant recipients. PTA is highly prevalent during the first week and improves over time. Other haematological abnormalities observed were leukopenia, thrombocytopenia, pancytopenia, and post-transplant erythrocytosis. Leucopenia was primarily drug-induced, and thrombocytopenia and pancytopenia were frequently caused by infections in our cohort. Additionally, severe PTA was significantly associated with graft dysfunction in the first week post-transplant, whereas similar graft function was observed at 6 and 12 months post-transplant, irrespective of the presence or absence of PTA.

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Section: Discussionmentioning

confidence: 82%

Post kidney transplant hematologic abnormalities and association of post-transplant anemia with graft function

Laxminarayana,

Jayaram,

Swaminathan

et al. 2024

F1000Res

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“…A meta-analysis addressing the effect of anemia on graft survival including 11 observational studies and 11,632 KTRs reported a consistent association between anemia and poor graft outcome, 32 as confirmed by several subsequent studies. 2 , 4 , 33 , 34 , 35 During a mean follow-up time of 5.4 years, KTRs with both early (6 months) and late (2 years) anemia reported a significantly higher percentage of graft failure at 4 years than did patients without anemia. 4 In a cohort of 1,139 KTRs (412 anemic), during a median of 5.5 year follow-up, the presence of severe anemia (hemoglobin [Hb] concentration of <11 g/dL) was significantly associated with death-censored graft failure, the association being weaker for mild anemia.…”

Section: Causes Of Posttransplant Anemiamentioning

confidence: 97%

“…A recent meta-analysis and systematic review showed a significantly increased risk of CVD death and major adverse cardiovascular events in anemic KTRs when compared with those without anemia. 35 …”

Section: Causes Of Posttransplant Anemiamentioning

confidence: 99%

Treatment Options for Anemia in Kidney Transplant Patients: A Review

2023

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“…A recent meta-analysis indicated that post-transplantation anemia was linked to higher overall mortality (pooled risk ratio = 1.72 [1.39, 2.13], I2 = 56%), graft loss (pooled risk ratio = 2.28 [1.77, 2.93], I2 = 94%), cardiovascular death (pooled risk ratio = 2.06 [1.35, 3.16], I2 = 0%), and cardiovascular events (pooled risk ratio = 1.33 [1.10, 1.61], I2 = 0%). Early anemia (≤6 months) carried a higher risk of overall mortality and graft loss compared to late anemia (>6 months), with a pooled risk ratio of 2.63 (95% CI 1.79-3.86; I2 = 0%) and 2.96 (95% CI 2.29-3.82; I2 = 0%), respectively [50]. An open-label French multicenter randomized controlled trial investigated the effect of epoetin-β on normalizing hemoglobin values (13.0-15.0 g/dL, n = 63) versus partial correction of anemia (10.5-11.5 g/dL, n = 62) in transplant recipients with hemoglobin < 11.5 g/dL and estimated creatinine clearance (eCrCl) < 50 mL/min per 1.73 m 2 .…”

Section: Haematological Disorders: Leukopenia and Anemiamentioning

confidence: 99%

Adverse Drug Events after Kidney Transplantation

Rostaing,

Jouve,

Terrec

et al. 2023

JPM

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Introduction: Kidney transplantation stands out as the optimal treatment for patients with end-stage kidney disease, provided they meet specific criteria for a secure outcome. With the exception of identical twin donor–recipient pairs, lifelong immunosuppression becomes imperative. Unfortunately, immunosuppressant drugs, particularly calcineurin inhibitors like tacrolimus, bring about adverse effects, including nephrotoxicity, diabetes mellitus, hypertension, infections, malignancy, leukopenia, anemia, thrombocytopenia, mouth ulcers, dyslipidemia, and wound complications. Since achieving tolerance is not feasible, patients are compelled to adhere to lifelong immunosuppressive therapies, often involving calcineurin inhibitors, alongside mycophenolic acid or mTOR inhibitors, with or without steroids. Area covered: Notably, these drugs, especially calcineurin inhibitors, possess narrow therapeutic windows, resulting in numerous drug-related side effects. This review focuses on the prevalent immunosuppressive drug-related side effects encountered in kidney transplant recipients, namely nephrotoxicity, post-transplant diabetes mellitus, leukopenia, anemia, dyslipidemia, mouth ulcers, hypertension, and viral reactivations (cytomegalovirus and BK virus). Additionally, other post-kidney-transplantation drugs such as valganciclovir may also contribute to adverse events such as leukopenia. For each side effect, we propose preventive measures and outline appropriate treatment strategies.

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A Systematic Review and Meta-Analysis of Posttransplant Anemia With Overall Mortality and Cardiovascular Outcomes Among Kidney Transplant Recipients

Cited by 8 publications

References 49 publications

Post kidney transplant hematologic abnormalities and association of post-transplant anemia with graft function

Post kidney transplant hematologic abnormalities and association of post-transplant anemia with graft function

Treatment Options for Anemia in Kidney Transplant Patients: A Review

Adverse Drug Events after Kidney Transplantation

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