Risk factors for chronic anemia in pediatric orthotopic liver transplantation: Analysis of data from the SPLIT registry

Abstract

Risk factors for chronic anemia in the post transplant period have not been clearly delineated in pediatric liver transplant recipients. We analyzed data from children transplanted from 2000 to 2008 with at least 2 consecutive hemoglobin values from follow-up between 6 months and 5 years post transplant. A multivariate model was derived to determine independent risk factors associated with chronic anemia. Of 1026 children in this analysis, 242 (23.6%) were found to have chronic anemia. On multivariate analysis, GI bleeding (OR 11.83 [2.08-67.49], P = 0.0054), presence of leukopenia (OR 9.55 [95% CI 3.71-24.62], P < 0.0001), use of cyclosporine (OR 3.69, [95% CI 1.56-8.76], P = 0.0039) and corticosteroids (OR 2.90 [95% CI 1.94-4.33], P < 0.0001), and calculated GFR < 90 mL/min/1.73m2 (OR 4.62 [95% CI 2.47-8.67], P < 0.0001) represented the most significant risk factors for chronic anemia. Use of anti-hypertensive medications (OR 1.89 [95% CI 1.23-2.91], P = 0.0039) was also significantly associated with a higher risk. In summary, chronic anemia is common in children following liver transplant. Our findings underscore the need to define the mechanisms by which these risk factors, some of which are modifiable, result in chronic anemia in pediatric liver transplant recipients.

The SPLIT Research Agenda 2013

“…Indeed, less than one‐third (32%) of patients achieved an “ideal” profile of a first allograft stable on immunosuppression monotherapy, normal growth, and absence of common immunosuppression‐induced sequelae . Multiple published, in press, and in preparation SPLIT manuscripts provide most commonly a cross‐sectional study analyses of some of these long‐term medical complications .…”

Cardiovascular Morbidity After Pediatric Liver Transplantation: A Matter of Life Expectancy?

“…Conversely, anemia is frequent among pediatric LT recipients with its multifactorial etiology. (12) Life expectancy of pediatric LT recipients is excellent. (2) Unmodifiable variables, such as donor age and the adversity of transplant and chronic illness in childhood, will undoubtedly remain.…”

“…Might rejection impact patient survival indirectly via its impact on CV health? Conversely, anemia is frequent among pediatric LT recipients with its multifactorial etiology …”

Medical management of children after liver transplantation

“…Risk factors included gastrointestinal bleeding, leukopenia, cyclosporine and steroid-based immunosuppression, calculated glomerular filtration rate less than 90 ml/min/1.73 m 2 , and use of antihypertensive medications [25]. Risk factors included gastrointestinal bleeding, leukopenia, cyclosporine and steroid-based immunosuppression, calculated glomerular filtration rate less than 90 ml/min/1.73 m 2 , and use of antihypertensive medications [25].…”