Anemia in the period immediately following renal transplantation.
BACKGROUND
Anemia remains frequent in the first month following renal transplantation and is a risk factor for cardiovascular accidents. The purpose of this study was to analyze the prevalence of anemia during this period notably among different immunosuppressive treatment groups.


METHODS
In this study, we entered the patients who had received a renal allograft in our transplant unit from 1993 to 2003, including patients who had received azathioprine (AZA) from 1993 to 1996 and mycophenolate mofetil (MMF) from 1996 to 2003. No patient received rHu-erythropoietin after transplantation during that period. A mathematical model normalized the hemoglobin (Hb) threshold level at which blood transfusion was decided and Hb on admission.


RESULTS
One hundred and eighty-eight patients on AZA and 223 on MMF were included in the analysis. The mean age +/- SD was 41 +/- 12 years in the AZA group, and 45 +/- 12 years in the MMF group (P < .006). Before the transplantation, Hb was higher in the MMF group (11.4 +/- 1.9 vs 10.2 +/- 2 g/dL, P < .0001). After normalization at a threshold level of transfusion of 7 g/dL, transfusions were more frequent among the MMF group (72% vs 48%, P < .0001). Double therapy with MMF (1500 mg/d) + steroids or therapy with MMF (750 mg/d) + tacrolimus + steroids increased the risk of transfusion compared to the AZA group. MMF (750 mg/d) + cyclosporine conferred a similar risk of transfusion compared with the AZA group.


CONCLUSIONS
MMF alone or in association with tacrolimus is associated with an increased risk of anemia and transfusion in the immediate posttransplantation period.
Ourahma
S
S
Department of Anesthesiology and Intensive Care, Pitié-Salpêtrière's Hospital, Assistance Publique-Hôpitaux de Paris, 83 boulevard de l'hôpital, 75013 Paris, France.
Mercadal
L
L
Tezenas du Montcel
S
S
Assogba
D
D
Bitker
M-O
MO
Mallet
A
A
Barrou
B
B
D000328:Adult; D000740:Anemia / Q000453:epidemiology*; D001379:Azathioprine / Q000627:therapeutic use; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D012189:Retrospective Studies
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D001379:Azathioprine