Unexpectedly high prevalence of posttransplant anemia in pediatric and young adult renal transplant recipients.
BACKGROUND
Although posttransplant anemia (PTA) is recognized as a common problem in adult renal transplant recipients, few pediatric studies have been published.


METHODS
In this retrospective cohort study of 162 pediatric renal transplant recipients treated at Stanford University, the authors sought to determine the prevalence, severity, and the predictive factors of PTA. Anemia was defined as a hematocrit (HCT) level greater than 2 SD below published means for age or as erythropoietin dependency to maintain a normal HCT.


RESULTS
Sixty-seven percent of pediatric renal transplant recipients were anemic at the time of transplantation. The prevalence of anemia increased to 84.3% in the first month posttransplant. From 6 months to 60 months posttransplant, the prevalence of anemia remained high at 64.2% to 82.2%. Only 4 patients (2.5%) were never anemic. Iron depletion was detected in 19 of 26 and 23 of 23 anemic patients 12 and 60 months posttransplant, respectively. Serum erythropoietin levels were low relative to hematocrit levels in 38 of 56 anemic patients. Logistic regression at 3 months posttransplant showed that discharge hematocrit level (P < 0.0001), calcium (P = 0.0004), and cyclosporine dose (P = 0.0002) correlated with anemia. Creatinine clearance (P = 0.002) and white blood cell count (P = 0.004) correlated with anemia at 12 months posttransplant, but only creatinine clearance (P = 0.011) correlated with anemia 60 months posttransplant.


CONCLUSIONS
Nearly all pediatric renal transplant recipients experience PTA. However, few children less than 2 years of age were anemic during the first year posttransplant. Antirejection therapy, bone disease, iron depletion, and creatinine clearance appear to play pivotal roles in the development of PTA in children.
Yorgin
Peter D
PD
Section of Pediatric Nephrology, Department of Pediatrics, Lucile Salter Packard Children's Hospital, Stanford University, Stanford, CA 94304, USA. pyorgin@stanford.edu
Belson
Amir
A
Sanchez
Jaime
J
Al Uzri
Amira Y
AY
Sarwal
Minnie
M
Bloch
Daniel A
DA
Oehlert
John
J
Salvatierra
Oscar
O
Alexander
Steven R
SR
D000293:Adolescent; D000740:Anemia / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology / Q000652:urine; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood / Q000378:metabolism / Q000652:urine; D004921:Erythropoietin / Q000097:blood; D005260:Female; D006801:Humans; D007223:Infant; D007501:Iron / Q000097:blood; D007668:Kidney / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D051437:Renal Insufficiency / Q000097:blood / Q000503:physiopathology / Q000628:therapy / Q000652:urine; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D004921:Erythropoietin; D003404:Creatinine; D007501:Iron