The impact of pretransplant erythropoietin therapy on late outcomes of renal transplantation.
OBJECTIVE
The introduction of recombinant erythropoietin (rHu-EPO) has been shown to reverse anemia of chronic renal failure and was able to almost completely obviate the need for repeated blood transfusions (BT), the most potent cause of allostimulation in renal transplant candidates. The series describes single center experience of the pretransplant BT and rHu-EPO therapy effects on late outcomes of cadaveric renal transplantation.


METHODS
We retrospectively analyzed data of 502 adult recipients of primary renal allograft between 1990-1997 whose graft survived > 6 months. In the study group 51 patients were treated prior to transplantation with de novo rHu-EPO therapy, 207 patients received BT, 184 patients were switched from BT to rHu-EPO therapy, and 60 patients did not require treatment. The groups were compared in respect to pretransplant % PRA, frequency of acute rejections and graft survival.


RESULTS
At one-year graft survival was similar between groups, however at five years recipients of de novo rHu-EPO and those who have converted from BT to rHu-EPO experienced only 7% graft loss, as compared to 22% of patients treated with BT, and 18% of patients who did not require treatment, p < 0.001. The pretransplant therapy with rHu-EPO was associated with decreased frequency of late episodes of rejection from 0.42 to 0.27, p = 0.03. There were no differences between groups in the number of highly sensitized (PRA > 20%) at the time of transplantation.


CONCLUSIONS
The use of rHu-EPO as de novo therapy or conversion from BT treatment to rHu-EPO prior to transplantation was associated with a decline in late posttransplant alloreactivity and improved late renal graft survival.
Lietz
Katarzyna
K
Department of Internal Medicine, Oklahoma, University Health Sciences Center, Oklahoma City, USA.
Lao
Mieczysław
M
Paczek
Leszek
L
Górski
Andrzej
A
Gaciong
Zbigniew
Z
D000328:Adult; D001803:Blood Transfusion; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000145:classification / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D008285:Major Histocompatibility Complex; D008297:Male; D011300:Preoperative Care; D011994:Recombinant Proteins; D012044:Regression Analysis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
D011994:Recombinant Proteins; D004921:Erythropoietin