Impact of pre-transplant anaemia correction and erythropoietin resistance on long-term graft survival.
BACKGROUND
This study investigated whether recombinant human erythropoietin (rHuEPO)-hyporesponsive anaemia before transplantation is associated with a poorer graft outcome and lower patient survival.


METHODS
A total of 15,051 kidney transplant recipients, with a minimum follow-up of 1 year, were stratified as either rHuEPO hyporesponsive or rHuEPO responsive (using a threshold rHuEPO-treated haemoglobin level of 11 g/dl). They were followed for a median of 24 months. Outcomes included times from transplantation to graft failure (including patient death), return to dialysis or pre-emptive re-transplantation, and death with a functioning graft.


RESULTS
The cumulative incidence of graft failure was 50% for rHuEPO-hyporesponsive patients, compared with 41.7% for rHuEPO responders (P = 0.0091). Among rHuEPO-hyporesponsive patients, 41.7% returned to dialysis or underwent a pre-emptive re-transplantation, compared with 32% of rHuEPO responders (P = 0.0091). Death with a functioning graft occurred in 16.9% of rHuEPO-hyporesponsive and in 15% of rHuEPO-responsive patients (P = 0.3949).


CONCLUSIONS
The results showed higher mortality and higher incidence of graft failure at 5 years for rHuEPO-hyporesponsive patients. It is unclear whether anaemia treatment per se or treatment of more severe co-morbidity resulting in hyporesponsiveness to anaemia treatment may be causally linked to reduced renal transplant outcomes.
Campise
Mariarosaria
M
UO Nefrologia, IRCCS Ospedale Maggiore, Via Commenda, 15, 20122 Milano, Italy. campise@policlinico.mi.it
Mikhail
Ashraf
A
Quaschning
Thomas
T
Snyder
Jon
J
Collins
Allan
A
D000328:Adult; D000368:Aged; D000740:Anemia / Q000188:drug therapy*; D004351:Drug Resistance; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins
D011994:Recombinant Proteins; D004921:Erythropoietin