Postrenal transplant anemia and its effects on patients and graft outcomes: Seven years follow-up

Nouf E Alotaibi; Bilal Mohsin; Shoroug Alharbi; Nasser O Odah; Douaa Sindi; Sarah Bargawi; Raghad B Abid; Mohammed Simsim; Aboud Alqurashi; Mustafa Badawi; Bashayer Alshehail; Abdulmalik Alotaibi

doi:10.1016/j.jsps.2023.101696

Postrenal transplant anemia and its effects on patients and graft outcomes: Seven years follow-up

Saudi Pharm J. 2023 Aug;31(8):101696. doi: 10.1016/j.jsps.2023.101696. Epub 2023 Jul 7.

Authors

Affiliations

¹ Umm Al-Qura university, Clinical pharmacy department, College of pharmacy, Makkah, Saudi Arabia.
² King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
³ King Faisal Specialist Hospital and Research Centre, Pharmaceutical Care Division, Jeddah, Saudi Arabia.
⁴ Department of medicine, King Faisal specialist hospital Jeddah, Saudi Arabia.
⁵ College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia.
⁶ Jamjoom Pharma, Makkah, Saudi Arabia.
⁷ Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia.

Abstract

Introduction: Post-transplant anemia (PTA) is a common serious complication following kidney transplantation. It affects graft and patient survival. Anemia that presents within six months post-transplantation is defined as an early PTA. Late PTA is when anemia occurs more than six months following transplantation. Despite this, there are limited studies on the long-term impact of anemia on patient survival and graft function in kidney transplants. We conducted a retrospective study with long-term follow-up to investigate the effect of early and late PTA on patient and graft function within seven years and to estimate the prevalence of PTA at six months, two, four, and seven years postrenal transplantation along with the associated risk factors.

Method: A retrospective chart review of 145 adult patients who had kidney transplants from January 1 to December 31, 2015, and were followed up until December 31, 2022. Anemia was defined according to the World Health Organization (WHO) criteria of hemoglobin<12 gm/dl in females and<13 mg/dl in males. Pretransplant, six months, two, four, and seven years postrenal transplantation medications and laboratory data were obtained. Patients were excluded if they were pediatrics or had missing data.

Result: 180 patients were screened, and 145 patients met the inclusion criteria. The prevalence of early PTA was 8.3%. Trimethoprim-sulfamethoxazole was significantly associated with anemia within six months. The prevalence of anemia increased at two, four-, and seven-years post-transplant (24.8%, 24.8%, and 27.6%, respectively). Graft failure was significantly associated with late PTA at four and seven years (p-value < 0.001). P < 0.005, respectively). Death was reported for 3 patients, and it was significantly associated with late transplant anemia (p-value < 0.005), Cytomegalovirus was associated with anemia at 6 months and 2 years post-transplant and significantly associated with graft failure (p-value < 0.037).

Conclusion: The results of this study indicate that post-transplant anemia is associated with graft failure and patient mortality. Therefore, managing anemia post-transplant should be addressed more carefully.

Keywords: Anemia; Death; Graft Survival; Graft failure; Kidney Transplantation.