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Early-Onset Anemia After Kidney Transplantation Is an Independent Factor for Graft Loss: A Multicenter, Observational Cohort Study

Pascual, Julio1; Jiménez, Carlos2; Franco, Antonio3; Gil, Mercedes4; Obrador-Mulet, Aina R.5; Gentil, Miguel Ángel6; Romero, Rafael7; Grinyó, Josep Ma8; Hernández, Domingo9; Morales, José M.10; Pallardó, Luis Manuel11; Serón, Daniel12; Arias, Manuel13; Campistol, Josep M.14on behalf of the ANEMIART Study Group

doi: 10.1097/TP.0b013e31829f162e
Clinical and Translational Research

Background The association of anemia with outcomes after renal transplantation (RT) is unclear.

Methods We performed a retrospective study that included patients who received a RT in Spain in 2007. We collected data on anemia (hemoglobin [Hb] <11 g/dL and/or erythropoietic agents and/or transfusion in the previous month) as well as transplantation and clinical data during follow-up. We used multivariate Cox models to predict graft and patient survival.

Results We included 639 patients; 7.2% lost their graft and 6.3% died. The prevalence of anemia was 84% at 7 days, 77% at 1 month, 41% at 2 months, 16% at 12 months, 14% at 24 months, and 18% at 36 months. After adjusting by glomerular filtration rate (hazard ratio [95% confidence interval], 0.96 [0.93–0.98]), low Hb levels at 1 month remained as an independent predictor of graft loss (hazard ratio for each 1 g/dL increase, 0.72 [0.54–0.96]) along with a maximum panel-reactive antibody of more than 10% (3.80 [1.73–8.36]), a donor with stroke (3.30 [1.31–8.28]), and one or more acute rejection episode (13.89 [4.78–40.37]). Tacrolimus use was a protective factor (0.24 [0.11–0.50]).

Conclusions Low Hb levels in the early posttransplantation period (1 month) seem to be an independent prognostic factor for graft loss, but not for mortality, in Spanish RT patients regardless of graft function, recipient and donor characteristics, unfavorable events within the first month, and immunosuppression.

1 Hospital del Mar, Barcelona, Spain.

2 Hospital Universitario La Paz, Madrid, Spain.

3 Hospital Universitario General de Alicante, Alicante, Spain.

4 Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.

5 Hospital Son Espases, Mallorca, Spain.

6 Hospital Universitario Virgen del Rocío, Sevilla, Spain.

7 Complejo Hospitalario Universitario Santiago, Santiago de Compostela, Spain.

8 Ciutat Sanitaria i Universitaria de Bellvitge, l’Hospitalet de Llobregat, Spain.

9 Hospital Regional Universitario Carlos Haya, Málaga, Spain.

10 Hospital 12 de Octubre, Madrid, Spain.

11 Hospital Universitario Dr. Peset, Valencia, Spain.

12 Hospital General Vall d’Hebron, Barcelona, Spain.

13 Hospital Universitario Marques de Valdecilla, Santander, Spain.

14 Hospital Clínic, Universidad de Barcelona, Institut d’Investigacions August Pi i Sunyer (IDIBAPS), Barcelona, Spain.

The study was conducted under the auspice of the Spanish Society of Transplantation. This study was supported in part by a grant from Amgen.

Amgen did not have any role in the study design; collection, analysis, and interpretation of data; writing of the article; and the decision to submit the article for publication. The authors declare no other conflicts of interest.

Address correspondence to: Dr. Julio Pascual, Nephrology Service, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, ES-08003 Barcelona, Spain.


J.P., J.M.G., D.H., J.M.M., L.M.M., D.S., M.A., and J.M.C. designed the study. M.A. and J.M.C. coordinated the working group. J.P. and D.H. reviewed the analysis. All authors contributed to clinical data collection, reviewed the article, and approved its final version.

Received 14 February 2013. Revision requested 11 March 2013.

Accepted 4 June 2013.

This is an open-access article distributed under the terms of the CreativeCommons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

Accepted August 1, 2013

© 2013 by Lippincott Williams & Wilkins