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

Abstract

Background Post transplantation anemia (PTA) is common among kidney transplant patients. PTA is associated with increased graft loss and in most studies with increased mortality. However, the effect of the severity of anemia on this associations was not thoroughly evaluated. Methods Patients who underwent kidney transplantation in Rabin Medical Center (RMC) were included in the study. Data were collected during the years 2002–2016. Anemia was defined as hemoglobin (Hb) level less than 12 g/dL in women and less than 13 g/dL in men, in accordance with World Health Organization (WHO) criteria. Severe anemia was defined as hemoglobin lower than 11 g/dL. Primary outcome was a composite of patient and graft survival. We used univariate and multivariate models to evaluate association between severity and specific causes of anemia with the outcomes. As the risk associated with anemia changed over time we analyzed the risk separately for the early and the late period (before and after 1251 days). Results Our cohort included 1139 patients, 412 (36.2%) of which had PTA and 134 (11.7%) had severe anemia. On multivariable analysis, severe anemia was highly associated with the primary outcome at the early period (HR 6.26, 95% CI 3.74–10.5, p < 0.001). Anemia due to either AKI & acute rejection (11.9% of patients) or infection (16.7%), were associated with primary outcome at the early period (HR 9.32, 95% CI 5.3–26.41, p < 0.001 and HR 3.99, 95% CI 2.01–7.95, p < 0.001, respectively). There was non-significant trend for association between anemia due to Nutritional deficiencies (29.1%) and this outcome (HR 3.07, 95% CI 0.93–10.17, p = 0.067). Conclusion PTA is associated with graft loss and mortality especially during the first three years. Anemia severity affects this association. An anemia workup is recommended for PTA. Electronic supplementary material The online version of this article (10.1186/s12882-019-1244-y) contains supplementary material, which is available to authorized users.

Two-Stage Joint Model for Multivariate Longitudinal and Multistate Processes, with Application to Renal Transplantation Data

“…In fact, the levels of these biomarkers will increase in patients with a dysfunctional graft, and this increase is translated to a higher risk of rejection or mortality [20][21][22][23]. On the other hand, less hemoglobin level in the post-transplant period has been known to be associated with an increased risk of graft loss and mortality [24,25] that was consistent with our findings. Moreover, some transplant medications are known to be associated with low levels of hemoglobin (anemia) [24], and the increased risk may be caused by these treatments.…”

Multifaceted Sexual Dysfunction in Dialyzing Men and Women: Pathophysiology, Diagnostics, and Therapeutics

“…There is scant information on anemia and the treatment of anemia in PD patients [ 29 ]. The prevalence of anemia remains high after RT at approximately 36–40% [ 30 , 31 ] and is associated with increased mortality [ 31 , 32 ].…”

Impact of immediate post‐transplant parenteral iron therapy on the prevalence of anemia and short‐term allograft function in a cohort of pediatric and adolescent renal transplant recipients

“…[35][36][37] As shown in similar studies, although not statistically significant in our cohort, subjects treated with intravenous iron had a lower rate of ARE, infections, and hospitalizations. 1,3,6,38,39 In a study by Schechter et al, 40 anemia was also likely to occur in the context of ARE, and the occurrence of both events increased the likelihood of future graft loss and mortality rate by 6-fold and 9-fold, respectively.…”