Skip to main content
Top
Published in: Clinical and Experimental Nephrology 4/2009

01-08-2009 | Original Article

Does posttransplant anemia at 6 months affect long-term outcome of live-donor kidney transplantation? A single-center experience

Authors: Osama Gheith, Ehab Wafa, Nabil Hassan, Amani Mostafa, Hussein A. Sheashaa, Khaled Mahmoud, Ahmed Shokeir, Mohamed A. Ghoneim

Published in: Clinical and Experimental Nephrology | Issue 4/2009

Login to get access

Abstract

Background/Aims

Posttransplantation anemia (PTA) frequently occurs. We aimed to assess the prevalence of anemia at 6 months of transplantation in patients under different protocols of immunosuppression, and to determine the impact of anemia on long-term patient and graft survival.

Methods

We included 832 renal transplant recipients who were categorized at 6 months according to hemoglobin (Hb) level into two groups: the first group, with Hb >13 g/dl in males and >12 g/dl in females (group I, 385 cases); and the second group, with Hb <13 g/dl in males and <12 g/dl in females (group II, 447 cases). We compared the two groups regarding posttransplant complications as well as patient and graft survival.

Results

Although there was no significant difference between the two groups regarding acute rejection episodes, chronic allograft nephropathy was significantly higher in the anemic group. Other posttransplant medical complications were comparable in both groups. Graft survival was significantly higher in the nonanemic group. However, no difference in patient survival was detected.

Conclusion

From this study, we can conclude that prevalence of PTA is high, especially in females and those receiving calcineurine inhibitors (CNI) and mycophenolate mofetil (MMF), and that it was associated with poorer graft outcome but with no effect on patient survival.
Literature
1.
go back to reference Vlagopoulos PT, Tighiouart H, Weiner DE, et al. Anemia as a risk factor for cardiovascular disease and all-cause mortality in diabetes: the impact of chronic kidney disease. J Am Soc Nephrol. 2005;16:3403–10.CrossRefPubMed Vlagopoulos PT, Tighiouart H, Weiner DE, et al. Anemia as a risk factor for cardiovascular disease and all-cause mortality in diabetes: the impact of chronic kidney disease. J Am Soc Nephrol. 2005;16:3403–10.CrossRefPubMed
2.
go back to reference Augustine JJ, Knauss TC, Schulak JA, Bodziak KA, Siegel C, Hricik DE. Comparative effects of sirolimus and mycophenolate mofetil on erythropoiesis in kidney transplant patients. Am J Transplant. 2004;4:2001–6.CrossRefPubMed Augustine JJ, Knauss TC, Schulak JA, Bodziak KA, Siegel C, Hricik DE. Comparative effects of sirolimus and mycophenolate mofetil on erythropoiesis in kidney transplant patients. Am J Transplant. 2004;4:2001–6.CrossRefPubMed
3.
go back to reference Mitsnefes MM, Subat-Dezulovic M, Khoury PR, Goebel J. Strife CF: increasing incidence of post-kidney transplant anemia in children. Am J Transplant. 2005;5:1713–8.CrossRefPubMed Mitsnefes MM, Subat-Dezulovic M, Khoury PR, Goebel J. Strife CF: increasing incidence of post-kidney transplant anemia in children. Am J Transplant. 2005;5:1713–8.CrossRefPubMed
4.
go back to reference Rigatto C, Foley R, Jeffery J, Negrijn C, Tribula C, Parfrey P. Electrocardiographic left ventricular hypertrophy in renal transplant recipients: prognostic value and impact of blood pressure and anemia. J Am Soc Nephrol. 2003;14:462–8.CrossRefPubMed Rigatto C, Foley R, Jeffery J, Negrijn C, Tribula C, Parfrey P. Electrocardiographic left ventricular hypertrophy in renal transplant recipients: prognostic value and impact of blood pressure and anemia. J Am Soc Nephrol. 2003;14:462–8.CrossRefPubMed
5.
go back to reference Ponticelli C, Villa M. Role of anaemia in cardiovascular mortality and morbidity in transplant patients. Nephrol Dial Transplant. 2002;17(1):41–6.CrossRefPubMed Ponticelli C, Villa M. Role of anaemia in cardiovascular mortality and morbidity in transplant patients. Nephrol Dial Transplant. 2002;17(1):41–6.CrossRefPubMed
6.
go back to reference Imoagene-Oyedeji AE, Rosas SE, Doyle AM, Goral S, Bloom RD. Posttransplantation anemia at 12 months in kidney recipients treated with mycophenolate mofetil: risk factors and implications for mortality. J Am Soc Nephrol. 2006;17:3240–7.CrossRefPubMed Imoagene-Oyedeji AE, Rosas SE, Doyle AM, Goral S, Bloom RD. Posttransplantation anemia at 12 months in kidney recipients treated with mycophenolate mofetil: risk factors and implications for mortality. J Am Soc Nephrol. 2006;17:3240–7.CrossRefPubMed
7.
go back to reference Hsu CY, McCulloch CE, Curhan GC. Epidemiology of anemia associated with chronic renal insufficiency among adults in the United States: results from the Third National Health and Nutrition Examination Survey. J Am Soc Nephrol. 2002;13:504–10.CrossRefPubMed Hsu CY, McCulloch CE, Curhan GC. Epidemiology of anemia associated with chronic renal insufficiency among adults in the United States: results from the Third National Health and Nutrition Examination Survey. J Am Soc Nephrol. 2002;13:504–10.CrossRefPubMed
8.
go back to reference Shah N, Al-Khoury S, Afzali B, Covic A, Roche A, Marsh J, et al. Posttransplantation anemia in adult renal allograft recipients: prevalence and predictors. Transplantation. 2006;81:1112–8.CrossRefPubMed Shah N, Al-Khoury S, Afzali B, Covic A, Roche A, Marsh J, et al. Posttransplantation anemia in adult renal allograft recipients: prevalence and predictors. Transplantation. 2006;81:1112–8.CrossRefPubMed
9.
go back to reference Afzali B, Al-Khoury S, Shah N, Mikhail A, Covic A, Goldsmith D. Anemia after transplantation. Am J Kidney Dis. 2006;48:519–36.CrossRefPubMed Afzali B, Al-Khoury S, Shah N, Mikhail A, Covic A, Goldsmith D. Anemia after transplantation. Am J Kidney Dis. 2006;48:519–36.CrossRefPubMed
11.
go back to reference Vanrenterghem Y, Ponticelli C, Morales JM, et al. Prevalence and management of anemia in renal transplant recipients: a European survey. Am J Transplant. 2003;3:835–45.CrossRefPubMed Vanrenterghem Y, Ponticelli C, Morales JM, et al. Prevalence and management of anemia in renal transplant recipients: a European survey. Am J Transplant. 2003;3:835–45.CrossRefPubMed
12.
go back to reference Molnar MZ, Novak M, Ambrus C, et al. Anemia in kidney transplanted patients. Clin Transplant. 2005;19:825–33.CrossRefPubMed Molnar MZ, Novak M, Ambrus C, et al. Anemia in kidney transplanted patients. Clin Transplant. 2005;19:825–33.CrossRefPubMed
13.
go back to reference Winkelmayer WC, Lorenz M, Kramar R, Horl WH, Sunder-Plassmann G. Percentage of hypochromic red blood cells is an independent risk factor for mortality in kidney transplant recipients. Am J Transplant. 2004;4:2075–81.CrossRefPubMed Winkelmayer WC, Lorenz M, Kramar R, Horl WH, Sunder-Plassmann G. Percentage of hypochromic red blood cells is an independent risk factor for mortality in kidney transplant recipients. Am J Transplant. 2004;4:2075–81.CrossRefPubMed
14.
go back to reference Heinze G, Mitterbauer C, Regele H, et al. Angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor antagonist therapy is associated with prolonged patient and graft survival after renal transplantation. J Am Soc Nephrol. 2006;17:889–99.CrossRefPubMed Heinze G, Mitterbauer C, Regele H, et al. Angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor antagonist therapy is associated with prolonged patient and graft survival after renal transplantation. J Am Soc Nephrol. 2006;17:889–99.CrossRefPubMed
15.
go back to reference Kamar N, Rostaing L. Negative impact of one-year anemia on long-term patient and graft survival in kidney transplant patients receiving calcineurin inhibitors and mycophenolate mofetil. Transplantation. 2008;85(8):1120–4.CrossRefPubMed Kamar N, Rostaing L. Negative impact of one-year anemia on long-term patient and graft survival in kidney transplant patients receiving calcineurin inhibitors and mycophenolate mofetil. Transplantation. 2008;85(8):1120–4.CrossRefPubMed
16.
go back to reference Molnar MZ, Czira M, Ambrus C, Szeifert L, Szentkiralyi A, Beko G, et al. Anemia is associated with mortality in kidney-transplanted patients—a prospective cohort study. Am J Transplant. 2007;7(4):731–2.CrossRef Molnar MZ, Czira M, Ambrus C, Szeifert L, Szentkiralyi A, Beko G, et al. Anemia is associated with mortality in kidney-transplanted patients—a prospective cohort study. Am J Transplant. 2007;7(4):731–2.CrossRef
17.
go back to reference Kovesdy CP, Trivedi BK, Kalantar-Zadeh K, Anderson JE. Association of anemia with outcomes in men with moderate and severe chronic kidney disease. Kidney Int. 2006;69:560–4.CrossRefPubMed Kovesdy CP, Trivedi BK, Kalantar-Zadeh K, Anderson JE. Association of anemia with outcomes in men with moderate and severe chronic kidney disease. Kidney Int. 2006;69:560–4.CrossRefPubMed
18.
go back to reference Rigatto C, Parfrey P, Foley R, Negrijn C, Tribula C, Jeffery J. Congestive heart failure in renal transplant recipients: risk factors, outcomes, and relationship with ischemic heart disease. J Am Soc Nephrol. 2002;13:1084–90.PubMed Rigatto C, Parfrey P, Foley R, Negrijn C, Tribula C, Jeffery J. Congestive heart failure in renal transplant recipients: risk factors, outcomes, and relationship with ischemic heart disease. J Am Soc Nephrol. 2002;13:1084–90.PubMed
19.
go back to reference Laina A, Silverberg DS, Wexler D. Therapy insight: congestive heart failure, chronic kidney disease and anemia, the cardio-renal-anemia syndrome. Nat Clin Pract Cardiovasc Med. 2005;2:95–100.CrossRef Laina A, Silverberg DS, Wexler D. Therapy insight: congestive heart failure, chronic kidney disease and anemia, the cardio-renal-anemia syndrome. Nat Clin Pract Cardiovasc Med. 2005;2:95–100.CrossRef
20.
go back to reference Gleissner CA, Murat A, Schafer S, et al. Reduced hemoglobin after heart transplantation is no independent risk factor for survival but is associated closely with impaired renal function. Transplantation. 2004;77:710–7.CrossRefPubMed Gleissner CA, Murat A, Schafer S, et al. Reduced hemoglobin after heart transplantation is no independent risk factor for survival but is associated closely with impaired renal function. Transplantation. 2004;77:710–7.CrossRefPubMed
21.
go back to reference Afzali B, Al-Khoury S, Shah N, Mikhail A, Covic A, Goldsmith D. Anemia after renal transplantation. Am J Kidney Dis. 2006;48(4):519–36.CrossRefPubMed Afzali B, Al-Khoury S, Shah N, Mikhail A, Covic A, Goldsmith D. Anemia after renal transplantation. Am J Kidney Dis. 2006;48(4):519–36.CrossRefPubMed
22.
go back to reference Roger SD, McMahon LP, Clarkson A. Effects of early and late intervention with epoetin alpha on left ventricular mass among patients with chronic kidney disease (stage 3 or 4): results of a randomized clinical trial. J Am Soc Nephrol. 2004;15:148–56.CrossRefPubMed Roger SD, McMahon LP, Clarkson A. Effects of early and late intervention with epoetin alpha on left ventricular mass among patients with chronic kidney disease (stage 3 or 4): results of a randomized clinical trial. J Am Soc Nephrol. 2004;15:148–56.CrossRefPubMed
23.
go back to reference Locatelli F, Pisoni RL, Combe C. Anemia in hemodialysis patients of five European countries: association with morbidity and mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2004;19:121–32.CrossRefPubMed Locatelli F, Pisoni RL, Combe C. Anemia in hemodialysis patients of five European countries: association with morbidity and mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2004;19:121–32.CrossRefPubMed
24.
go back to reference Gouva C, Nikolopoulos P, Ioannidis JP. Treating anemia early in renal failure patients slows the decline of renal function: a randomized controlled trial. Kidney Int. 2004;66:753–60.CrossRefPubMed Gouva C, Nikolopoulos P, Ioannidis JP. Treating anemia early in renal failure patients slows the decline of renal function: a randomized controlled trial. Kidney Int. 2004;66:753–60.CrossRefPubMed
25.
go back to reference Vanrenterghem Y. Anaemia after renal transplantation. Nephrol Dial Transplant. 2004;19:54.CrossRef Vanrenterghem Y. Anaemia after renal transplantation. Nephrol Dial Transplant. 2004;19:54.CrossRef
26.
go back to reference Rigatto C, Foley R, Jeffery J, et al. Electrocardiographic left ventricular hypertrophy in renal transplant recipients: prognostic value and impact of blood pressure and anemia. J Am Soc Nephrol. 2003;14(2):462.CrossRefPubMed Rigatto C, Foley R, Jeffery J, et al. Electrocardiographic left ventricular hypertrophy in renal transplant recipients: prognostic value and impact of blood pressure and anemia. J Am Soc Nephrol. 2003;14(2):462.CrossRefPubMed
27.
go back to reference Djamali A, Becker YT, Simmons WD, et al. Increasing hematocrit reduces early posttransplant cardiovascular risk in diabetic transplant recipients. Transplantation. 2003;76(5):816.CrossRefPubMed Djamali A, Becker YT, Simmons WD, et al. Increasing hematocrit reduces early posttransplant cardiovascular risk in diabetic transplant recipients. Transplantation. 2003;76(5):816.CrossRefPubMed
28.
go back to reference Lorenz M, Winkelmayer WC, Horl WH, Sunder-Plassmann G. Anaemia after renal transplantation. Eur J Clin Invest. 2005;35(3):89.CrossRefPubMed Lorenz M, Winkelmayer WC, Horl WH, Sunder-Plassmann G. Anaemia after renal transplantation. Eur J Clin Invest. 2005;35(3):89.CrossRefPubMed
29.
go back to reference Winkelmayer WC, Kewalramani R, Rutstein M, et al. Pharmacoepidemiology of anemia in kidney transplant recipients. J Am Soc Nephrol. 2004;15(5):1347.CrossRefPubMed Winkelmayer WC, Kewalramani R, Rutstein M, et al. Pharmacoepidemiology of anemia in kidney transplant recipients. J Am Soc Nephrol. 2004;15(5):1347.CrossRefPubMed
30.
go back to reference Karakus S, Kanbay M, Koseoglu HK, et al. Causes of anemia in renal transplant recipients. Transplant Proc. 2004;36(1):164.CrossRefPubMed Karakus S, Kanbay M, Koseoglu HK, et al. Causes of anemia in renal transplant recipients. Transplant Proc. 2004;36(1):164.CrossRefPubMed
31.
go back to reference Chadban SJ, Baines L, Polkinghorne K, Jefferys A, Dogra S, Kanganas C, et al. Anemia after kidney transplantation is not completely explained by reduced kidney function. Am J Kidney Dis. 2007;49(2):301–9.CrossRefPubMed Chadban SJ, Baines L, Polkinghorne K, Jefferys A, Dogra S, Kanganas C, et al. Anemia after kidney transplantation is not completely explained by reduced kidney function. Am J Kidney Dis. 2007;49(2):301–9.CrossRefPubMed
32.
go back to reference Yorgin PD, Belson A, Sanchez J, et al. Unexpectedly high prevalence of posttransplant anemia in pediatric and young adult kidney transplant recipients. Am J Kidney Dis. 2002;40:1306–18.CrossRefPubMed Yorgin PD, Belson A, Sanchez J, et al. Unexpectedly high prevalence of posttransplant anemia in pediatric and young adult kidney transplant recipients. Am J Kidney Dis. 2002;40:1306–18.CrossRefPubMed
33.
go back to reference Ibrahim Barbara, et al. Transitions to adulthood: a National Survey of Egyptian adolescents. Cairo: The Population Council; 1999. Ibrahim Barbara, et al. Transitions to adulthood: a National Survey of Egyptian adolescents. Cairo: The Population Council; 1999.
34.
go back to reference Chhabra D, Grafals M, Skaro A, Parker M, Gallon L. Impact of anemia after renal transplantation on patient and graft survival and on rate of acute rejection. CJASN. 2008;3(4):1168–74.CrossRefPubMedPubMedCentral Chhabra D, Grafals M, Skaro A, Parker M, Gallon L. Impact of anemia after renal transplantation on patient and graft survival and on rate of acute rejection. CJASN. 2008;3(4):1168–74.CrossRefPubMedPubMedCentral
35.
go back to reference Offermann G. Immunosuppression for long-term maintenance of renal allograft function. Drugs. 2004;64:1325–38.CrossRefPubMed Offermann G. Immunosuppression for long-term maintenance of renal allograft function. Drugs. 2004;64:1325–38.CrossRefPubMed
36.
go back to reference Nangaku M. Chronic hypoxia and tubulointerstitial injury: a final common pathway to end-stage renal failure. J Am Soc Nephrol. 2006;17:17–25.CrossRefPubMed Nangaku M. Chronic hypoxia and tubulointerstitial injury: a final common pathway to end-stage renal failure. J Am Soc Nephrol. 2006;17:17–25.CrossRefPubMed
Metadata
Title
Does posttransplant anemia at 6 months affect long-term outcome of live-donor kidney transplantation? A single-center experience
Authors
Osama Gheith
Ehab Wafa
Nabil Hassan
Amani Mostafa
Hussein A. Sheashaa
Khaled Mahmoud
Ahmed Shokeir
Mohamed A. Ghoneim
Publication date
01-08-2009
Publisher
Springer Japan
Published in
Clinical and Experimental Nephrology / Issue 4/2009
Print ISSN: 1342-1751
Electronic ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-009-0171-9

Other articles of this Issue 4/2009

Clinical and Experimental Nephrology 4/2009 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.