title: Comparative effects of sirolimus and mycophenolate mofetil on erythropoiesis in kidney transplant patients.
abstract: Anemia and erythrocytosis (PTE) are common after kidney transplantation. We sought to determine the influence of sirolimus compared to mycophenolate mofetil (MMF) on post-transplant erythropoiesis. A total of 214 patients with recent kidney or kidney-pancreas transplants were treated with either sirolimus-based (n = 87) or MMF-based (n = 127) therapy. At 12 months, the prevalence of anemia was 31% with MMF and 57% with sirolimus (p < 0.001). Linear regression was used to examine the independent influence of sirolimus on hemoglobin at 12 months, controlling for multiple factors including gender and renal function. Sirolimus remained a significant correlate of lower hemoglobin in all patients (slope =-1.060, 95% CI: -1.76 to -0.362, p = 0.003), and in patients without PTE (slope =-0.671, 95% CI: -1.32 to -0.028, p = 0.041). PTE, defined as a persistent hematocrit above 51%, occurred in 19% with MMF and 7% with sirolimus (p = 0.013). PTE was examined using logistic regression analysis. Sirolimus use correlated negatively with PTE (odds ratio with sirolimus = 0.33, 95% CI: 0.12 to 0.89, p = 0.028). Our results indicate that, compared to treatment with MMF, treatment of kidney or kidney-pancreas recipients with sirolimus is associated with a higher prevalence of anemia, lower hemoglobin levels and lower incidence of PTE.
authors.affiliation: Department of Nephrology, Case Western University Hospitals, Cleveland, OH, USA. joshua.augustine@uhhs.com
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Augustine
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Knauss
authors.forename: James A
authors.initials: JA
authors.lastname: Schulak
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Bodziak
authors.forename: Christopher
authors.initials: C
authors.lastname: Siegel
authors.forename: Donald E
authors.initials: DE
authors.lastname: Hricik
mesh_terms: D000740:Anemia / Q000209:etiology* / Q000517:prevention & control; D004920:Erythropoiesis / Q000187:drug effects*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000502:physiology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D014019:Tissue Donors
chemical_list: D006454:Hemoglobins; D007166:Immunosuppressive Agents