Understanding renal posttransplantation anemia in the pediatric population

Abstract

Advances in renal transplantation management have proven to be beneficial in improving graft and patient survival. One of the properties of a well-functioning renal allograft is the secretion of adequate amounts of the hormone erythropoietin to stimulate erythropoiesis. Posttransplantation anemia (PTA) may occur at any point in time following transplantation, and the cause is multifactoral. Much of our understanding of PTA is based on studies of adult transplant recipients. The limited number of studies that have been reported on pediatric renal transplant patients appear to indicate that PTA is prevalent in this patient population. Erythropoietin deficiency or resistance is commonly associated with iron deficiency. An understanding of the risk factors, pathophysiology and management of PTA in the pediatric renal transplant population may provide guidelines for clinicians and researchers in the pursuit of larger prospective randomized control studies aimed at improving our limited knowledge of PTA. Recognition of PTA through regular screening and evaluation of the multiple factors that may contribute to its development are recommended after transplantation.

Anemia and markers of erythropoiesis in pediatric kidney transplant recipients compared to children with chronic renal failure

“…Anemia is a well‐known complication of CKD, yet PTA has received less attention and its causes are not completely understood . Data on PTA in pediatric kidney graft recipients are scarce . To the best of our knowledge, the present study is the first to compare the prevalence of anemia and various parameters of erythropoiesis between TX children and those with CKD prior to initiation of RRT.…”

“…6,[13][14][15] Data on PTA in pediatric kidney graft recipients are scarce. 4,5,10 To the best of our knowledge, the present study is the first to compare the prevalence of anemia and various parameters of erythropoiesis between TX children and those with CKD prior to initiation of RRT.…”

“…As PTA cannot be solely attributed to impaired kidney function, other factors have been implicated in its pathogenesis. Iron deficiency is one of the major causes of anemia both in CKD and in TX patients . Iron depletion may result in low intake, decreased absorption, and blood losses during dialysis or surgery.…”

“…Iron deficiency is one of the major causes of anemia both in CKD and in TX patients. 10,14,15 Iron depletion may result in low intake, decreased absorption, and blood losses during dialysis or surgery. The gold standard for diagnosing iron deficiency is bone marrow assessment.…”

“…Several other factors may be associated with PTA such as a chronic state of inflammation, iron deficiency, infections, and a suppressive effect of immunosuppressant drugs on erythropoiesis . To the best of our knowledge, there are no studies comparing the prevalence of anemia and markers of erythropoiesis to pediatric kidney recipients and children with CKD, prior to initiation of RRT.…”