title: Early-onset anemia after kidney transplantation is an independent factor for graft loss: a multicenter, observational cohort study.
abstract: BACKGROUND
  The association of anemia with outcomes after renal transplantation (RT) is unclear.
  
  
  METHODS
  We performed a retrospective study that included patients who received a RT in Spain in 2007. We collected data on anemia (hemoglobin [Hb] <11 g/dL and/or erythropoietic agents and/or transfusion in the previous month) as well as transplantation and clinical data during follow-up. We used multivariate Cox models to predict graft and patient survival.
  
  
  RESULTS
  We included 639 patients; 7.2% lost their graft and 6.3% died. The prevalence of anemia was 84% at 7 days, 77% at 1 month, 41% at 2 months, 16% at 12 months, 14% at 24 months, and 18% at 36 months. After adjusting by glomerular filtration rate (hazard ratio [95% confidence interval], 0.96 [0.93-0.98]), low Hb levels at 1 month remained as an independent predictor of graft loss (hazard ratio for each 1 g/dL increase, 0.72 [0.54-0.96]) along with a maximum panel-reactive antibody of more than 10% (3.80 [1.73-8.36]), a donor with stroke (3.30 [1.31-8.28]), and one or more acute rejection episode (13.89 [4.78-40.37]). Tacrolimus use was a protective factor (0.24 [0.11-0.50]).
  
  
  CONCLUSIONS
  Low Hb levels in the early posttransplantation period (1 month) seem to be an independent prognostic factor for graft loss, but not for mortality, in Spanish RT patients regardless of graft function, recipient and donor characteristics, unfavorable events within the first month, and immunosuppression.
authors.affiliation: 1 Hospital del Mar, Barcelona, Spain. 2 Hospital Universitario La Paz, Madrid, Spain. 3 Hospital Universitario General de Alicante, Alicante, Spain. 4 Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. 5 Hospital Son Espases, Mallorca, Spain. 6 Hospital Universitario Virgen del Rocío, Sevilla, Spain. 7 Complejo Hospitalario Universitario Santiago, Santiago de Compostela, Spain. 8 Ciutat Sanitaria i Universitaria de Bellvitge, l'Hospitalet de Llobregat, Spain. 9 Hospital Regional Universitario Carlos Haya, Málaga, Spain. 10 Hospital 12 de Octubre, Madrid, Spain. 11 Hospital Universitario Dr. Peset, Valencia, Spain. 12 Hospital General Vall d'Hebron, Barcelona, Spain. 13 Hospital Universitario Marques de Valdecilla, Santander, Spain. 14 Hospital Clínic, Universidad de Barcelona, Institut d'Investigacions August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
authors.forename: Carlos
authors.initials: C
authors.lastname: Jiménez
authors.forename: Antonio
authors.initials: A
authors.lastname: Franco
authors.forename: Mercedes
authors.initials: M
authors.lastname: Gil
authors.forename: Aina R
authors.initials: AR
authors.lastname: Obrador-Mulet
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Gentil
authors.forename: Rafael
authors.initials: R
authors.lastname: Romero
authors.forename: Josep Ma
authors.initials: JM
authors.lastname: Grinyó
authors.forename: Domingo
authors.initials: D
authors.lastname: Hernández
authors.forename: José M
authors.initials: JM
authors.lastname: Morales
authors.forename: Luis Manuel
authors.initials: LM
authors.lastname: Pallardó
authors.forename: Daniel
authors.initials: D
authors.lastname: Serón
authors.forename: Manuel
authors.initials: M
authors.lastname: Arias
authors.forename: Josep M
authors.initials: JM
authors.lastname: Campistol
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000188:drug therapy / Q000401:mortality*; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006085:Graft Survival; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006454:Hemoglobins; D004921:Erythropoietin