Posttransplant anemia in solid organ recipients
Introduction
Anemia in organ recipients is relatively unique for a number of reasons. First, posttransplantation anemia (PTA) is an underrecognized complication; second, unlike in pretransplant chronic kidney disease (CKD) patients, anemia is commonly not related to kidney disease or level of kidney function; third, it encompasses nonrenal organ recipients (in part related to CKD in this population); fourth, outcomes data related to anemia are limited, especially in nonrenal organ recipients; and finally, many of our assumptions regarding clinical management of anemia are extrapolated from the nontransplant CKD setting.
Although anemia related to CKD has generated research, new interventions, and better understanding of underlying pathophysiology over the past decades, analysis of PTA has only more recently begun to produce similar appreciation for the causes and prevalence, influence on patient outcomes, mechanisms, and adverse effects of therapy. Because most of the published literature on PTA pertains to kidney recipients, this will represent the main focus of this review, incorporating relevant available information in the nonrenal organ transplant setting where appropriate.
Section snippets
Definition of PTA
Until now, no consensus criteria have been put forth to define PTA. This is partly because several fundamental factors need to be considered in standardizing a uniform definition. This includes the timing of hemoglobin level measurement after transplant (eg, a different level of hemoglobin may be anticipated at 2 weeks after surgery as compared with at 12 months) as well as patient age and sex and absolute hemoglobin level. It is consequently not surprising to note that the literature is
Prevalence of PTA
Despite the relative paucity of studies in this area, PTA has been best characterized in kidney transplant patients. The true prevalence of PTA is difficult to ascertain, as it is dependent on the transplanted organ, the time point of assessment, the definition as well as severity of anemia. Studies in kidney recipients have demonstrated a biphasic pattern of anemia in the contemporary immunosuppression era. As shown in Fig. 1, there is an initial phase of high PTA prevalence in the first 3 to
Causes of PTA
The reasons for the high prevalence of late PTA in organ recipients are myriad as reflected in Table 2. Many transplant recipients, renal or nonrenal, on the one hand, have significantly diminished/impaired kidney function from the outset of their transplant that may be a contributing factor to PTA. A study of 85 904 kidney recipients transplanted in the United States between 1987 and 1998 revealed that more than 70% of patients with functioning allografts at 1, 3, and 5 years posttranspant had
Effects of PTA on patient outcomes
Although the causes of PTA are now more comprehensively understood, the effect of anemia on patient and graft outcomes has not been firmly established. The inability to draw conclusions from the available retrospective studies is a result of the heterogeneous set of anemia definitions, the different analytic strategies, and in the nonrenal organ transplant population, a complete paucity of data.
Among kidney transplant recipients, multiple retrospective single-center and registry studies as well
PTA and cardiovascular disease
Several lines of mainly indirect evidence link anemia causally to CVD, in kidney transplant, CKD and CVD populations. Rigatto and coinvestigators [29] retrospectively assessed for congestive heart failure risk in a cohort of kidney transplant patients at least 1-year posttransplant and with no history of CVD. Despite adjustment for age, diabetes mellitus, donor status, and albumin, they were able to show that PTA is an independent risk factor for congestive heart failure in this population.
Correction of anemia and patient outcomes
There are currently no registries in the United States that collect data on treating anemia in the posttransplant setting. Without registries or controlled trials, there is limited evidence by which to better assess associations between PTA and outcomes and to subsequently base therapeutic decisions. Components of treatment of PTA include optimizing nutritional supplements, including iron, B12 and folate, use of ESAs, and finally treating underlying causes or modifying or removing offending
Summary
Through research performed for the past decade, we have come to learn that a large proportion of transplant recipients will develop anemia at some time point after transplantation [9]. Many factors influence the development and timing of posttransplant anemia, including donor and recipient age, acute rejection, and medications, both immunosuppressants as well as nonimmunosuppressants. Impaired renal allograft function does have a role in PTA, yet it commonly is present in the setting of other
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Post-Transplantation Anemia and Risk of Death Following Lung Transplantation
2022, Transplantation ProceedingsCitation Excerpt :In our study, we found that male sex was associated with increased odds of PTA. This was inconsistent with the general understanding of female sex being a risk factor of anemia in both transplanted and non-transplanted individuals [7,22,23,24], and the causes of our finding were not identifiable from our data. Results similar to ours have previously been shown in the aforementioned study from 1995, in which male recipients were statistically predominant in the anemic group [21].
Outcomes in patients with solid organ transplants undergoing cardiac surgery
2020, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Dialysis dependence alone has been shown to be an independent predictor of mortality in patients undergoing CABG.34-36 Transplant recipients are also prone to anemia, and post-transplant anemia is a predictor of cardiovascular morbidity and mortality in patients who undergo kidney transplants.37 Potential explanations include iron deficiency, acute rejection, and inflammation.
Anesthetic Considerations in Transplant Recipients for Nontransplant Surgery
2017, Anesthesiology ClinicsCitation Excerpt :Appropriate blood product management in transplant recipients is critical, because certain aspects of blood product administration are more prevalent or unique to transplant recipients. Posttransplant anemia (PTA) is an important consideration in patients presenting for surgery, having a prevalence rate between 45% and 78% in solid organ transplant recipients.4–7 Immunosuppressants, especially the antimetabolite agents, can directly have antiproliferative effects on the bone marrow.4
Cardiac Surgery in Patients With Previous Hepatic or Renal Transplantation: A Pair-Matched Study
2017, Annals of Thoracic SurgeryClinical risk factors associated with the post-transplant anemia in kidney transplant patients
2016, Transplant ImmunologyCitation Excerpt :Persistent anemia after renal transplantation leads to decreases in mental capacity and quality of life [6–10]. The prevalence of PTA has been shown to be 20–80% [10–13]. However, in contrast to anemia in patients with chronic kidney disease (CKD), PTA has attracted little interest.
Outcomes of Cardiac Surgery in Patients with Previous Solid Organ Transplantation (Kidney, Liver, and Pancreas)
2015, American Journal of Cardiology