title: Associations of pre-transplant anemia management with post-transplant delayed graft function in kidney transplant recipients.
abstract: BACKGROUND
  Delayed graft function (DGF) complicates kidney allograft outcomes in the immediate post-transplantation period. We hypothesized that in hemodialysis patients more severe anemia, iron deficiency, the requirement for higher doses of erythropoietin-stimulating agents (ESA), or blood transfusions prior to transplantation are associated with higher risk of DGF.
  
  
  METHODS
  Linking five-yr hemodialysis patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, we identified 11 836 hemodialysis patients. Using logistic regression analyses we examined the association between pre-transplant parameters and post-transplant DGF.
  
  
  RESULTS
  Patients were 49 ± 14 (mean ± SD) yr old and included 38% women, 27% blacks, and 26% diabetics. After adjusting for relevant covariates, pre-transplant blood transfusion was associated with 33% higher DGF risk (odds ratio [OR] = 1.33; 95% confidence interval [CI]: 1.19-1.48); and each 5000 U/wk increase of pre-transplant ESA dose with 5% higher DGF (OR = 1.05; 95% CI: 1.02-1.09). Compared to pre-transplant blood hemoglobin of 12-12.99 g/dL, there was 25% higher risk of DGF with blood hemoglobin 10-10.99 g/dL (OR = 1.25; 95% CI: 1.01-1.55), whereas blood hemoglobin ≥13 g/dL exhibited 15% higher risk of DGF (OR = 1.15; 95% CI: 0.98-1.34).
  
  
  CONCLUSIONS
  Pre-transplant blood transfusion, higher ESA dose, and either high or low blood hemoglobin but not iron markers are associated with higher risk of DGF.
authors.affiliation: Harold Simmons Center for Chronic Disease Research & Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90509-2910, USA.
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
authors.forename: Laszlo
authors.initials: L
authors.lastname: Rosivall
authors.forename: Suphamai
authors.initials: S
authors.lastname: Bunnapradist
authors.forename: Junichi
authors.initials: J
authors.lastname: Hoshino
authors.forename: Elani
authors.initials: E
authors.lastname: Streja
authors.forename: Mahesh
authors.initials: M
authors.lastname: Krishnan
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications / Q000188:drug therapy; D015331:Cohort Studies; D051799:Delayed Graft Function / Q000175:diagnosis / Q000209:etiology*; D019468:Disease Management; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D004921:Erythropoietin