Benefits of Erythropoietin in Renal Transplantation

Anemia identified one month after renal transplantation is predictive of anemia identified after twelve months

The aim of this study was to evaluate whether anemia identified earlier than 3 months postengraftment in modern era could be predictive of anemia at 12 months. Cross-sectional and cohort studies based on retrospective analysis of existing clinical records were performed. Data on recipient's age at transplantation, follow-up serum creatinine (SCR) and hemoglobin (Hb) on day 7 (D7), at month 1 (M1) and at month 3 (M3) postengraftment were collected. Outcome was anemia identified at 12 months (M12) postengraftment. There were 75 patients on D7, 74 at M1 and 61 at M3. Multiple linear regression model that included recipient's age at transplantation, Hb and creatinine on D7 and tested the risk for anemia at M12 retained only the age in the model, with the coefficient of 0,84 (P=0,001). The same model at M1 retained Hb and age, with the coefficients of 0,26 (P=0,03) and 0,81 (P=0,0002), respectively and at M3 it retained Hb and age, with the coefficients of 0,41 (P=0,004) and 0,70 (P=0,003), respectively. Anemia identified at M1 after renal transplantation is predictive of anemia at M12.

Erythropoietin Safety and Efficacy in Chronic Allograft Nephropathy

BACKGROUND

Patients with chronic allograft nephropathy (CAN) very frequently suffer anemia. Correction of anemia by means of recombinant erythropoietin (rEpo) is possible and useful, but safety and efficacy must be assessed.

METHODS

This multicenter, prospective, open study included patients with a cadaver renal transplant, CAN, and non-ferropenic anemia. The aim of the study was to determine the safety and efficacy of treatment with rEpo to target hematocrit (HCT) values around 35% and/or hemoglobin (Hb) levels of 11 g/dL.

RESULTS

Twenty-four patients were included: 71% males and 29% females aged 49.5 +/- 14 years. At last follow-up, 48% did not show anemia-related symptoms, and 19% experienced adverse events possibly or probably related to rEpo. In 86% of cases, anemia was corrected and in 71%, graft survival was conserved. Patients whose anemia was not corrected had poor initial renal function (sCr 5 +/- 1 mg/dL vs sCr 3.2 +/- 1 mg/dL, P = .028). Patients with graft survival showed correction of anemia (P = .001) on a relatively low dose of rEpo and without a significant increase in blood pressure.

CONCLUSIONS

All patients who had graft survival and only half of those who lost their graft showed a correction of anemia. The rEpo treatment neither accelerated nor decelerated renal failure. The difference between patients in whom anemia was corrected, or not, did not depend upon the previous level of HCT/Hb, but upon worse renal function. Thus, rEpo in patients with CAN is safe and effective, so administration should be initiated early to avoid adverse events deriving from anemia.

Anemia After Renal Transplantation

Anemia in the setting of chronic kidney disease is a well-recognized phenomenon that is associated with decreasing renal function and deficiency of or resistance to erythropoietin. However, anemia in the post-renal transplantation setting has received comparatively less attention in the literature. In this review, we aim critically to appraise the available literature regarding posttransplantation anemia, concentrating in particular on the prevalence of posttransplantation anemia, its etiopathogenesis, potential effects on morbidity and mortality, and the rationale for intervention and treatment. Despite deficiencies in the literature, we conclude that posttransplantation anemia is a common phenomenon that can occur either early or late posttransplantation, and its causation is usually multifactorial and includes contributions notably from poor or decreasing renal function, immunosuppression, and iron deficiency. Conversely, there is a shortage of well-conducted prospective studies looking at the morbidity attributable to posttransplantation anemia and a lack of trial evidence to determine whether intervention improves patient morbidity and outcome.

Medical Care of Kidney Transplant Recipients after the First Posttransplant Year

Kidney transplantation is the treatment of choice for patients with ESRD. Despite improvements in short-term patient and graft outcomes, there has been no major improvement in long-term outcomes. The use of kidney allografts from expanded-criteria donors, polyoma virus nephropathy, underimmunosuppression, and incomplete functional recovery after rejection episodes may play a role in the lack of improvement in long-term outcomes. Other factors, including cardiovascular disease, infections, and malignancies, also shorten patient survival and therefore reduce the functional life of an allograft. There is a need for interventions that improve long-term outcomes in kidney transplant recipients. These patients are a unique subset of patients with chronic kidney disease. Therefore, interventions need to address disease progression, comorbid conditions, and patient mortality through a multifaceted approach. The Kidney Disease Outcomes Quality Initiative from the National Kidney Foundation, the European Best Practice Guidelines, and the forthcoming Kidney Disease: Improving Global Outcomes clinical practice guidelines can serve as a cornerstone of this approach. The unique aspects of chronic kidney disease in the transplant recipient require the integration of specific transplant-oriented problems into this care schema and a concrete partnership among transplant centers, community nephrologists, and primary care physicians. This article reviews the contemporary aspects of care for these patients.