Impact of post‐transplant anemia on patient and graft survival rates after kidney transplantation: a meta‐analysis

Abstract

The impact of post-kidney transplant anemia (PTA) on patient and graft survival rates remains controversial. We performed a meta-analysis to evaluate its impact in causing death of a patient with a functioning graft (DPWFG) and death-censored graft loss (DCGL). A systematic review of 11 observational studies (11,632 kidney transplant patients) that reported the impact of PTA or hemoglobin (Hb) level on these endpoints was performed. Using the World Health Organization (WHO) definition (Hb <12 g/dL in women and Hb <13 g/dL in men), PTA was not associated with DPWFG when results were expressed as an adjusted hazard ratio (aHR: 1.23 [0.97-1.57]), but was associated with higher DPWFG when results were expressed as unadjusted rates (aHR: 2.48 [1.36-4.52]) and when cut-off level for anemia was lower than the WHO definition (aHR: 3.12 [1.92-5.07]). A -1 g/dL decrease in Hb level was associated with higher DPWFG rates (aHR: 1.19 [1.12-1.26]). Using WHO criteria, PTA was associated with higher DCGL rates when results were expressed as aHR (aHR: 1.53 [1.26-1.85]) or as unadjusted rates (aHR: 3.55 [2.36-5.33]); a -1 g/dL decrease in Hb level was associated with higher DCGL rates (aHR: 1.14 [1.11-1.16]). This meta-analysis reveals that the association between PTA and DPWFG varies with PTA definition and adjustment for confounders. In all sub-meta-analyses, PTA was significantly associated with DCGL.

Factors associated with anaemia in kidney transplant recipients in the first year after transplantation: a cross-sectional study

“…In the French DIVAT study, anaemia at 12 months based on World Health Organization (WHO) criteria was associated with reduced patient survival in those with chronic kidney disease (CKD) stages 1–3 [ 5 ]. Anaemia may also reduce graft survival [ 6 – 9 ], quality of life and affect mental health [ 10 , 11 ].…”

Impact of Early Blood Transfusion After Kidney Transplantation on the Incidence of Donor-Specific Anti-LA Antibodies

“…Afterward, anemia can be induced by the effects of myelotoxic immunosuppressive drugs, such as mycophenolic acid (MPA), mammalian target of rapamycin (mTOR) inhibitors, and polyclonal antibodies; by the use of angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers; or by impaired kidney function caused by interstitial fibrosis and tubular atrophy . Published data are conflicting on the effect of posttransplant anemia on both patient‐ and graft‐survival rates . Correction of anemia relies on giving erythropoietin‐stimulating agents and/or blood transfusions.…”

Post-transplantation Anemia Predicts Cardiovascular Morbidity and Poor Graft Function in Kidney Transplant Recipients

“…We also can not explain whether cardiovascular deterioration is the result of anemia or poor graft function [17,18]. This study can not show beneficial effects of correction of anemia on the cardiovascular parameters, but raises a possibility that early correction of risk factors such as anemia and proteinuria may decrease the cardiovascular morbidity and mortality of the renal transplant patients [6,17].…”