title: Influence of anemia on patient and graft survival after renal transplantation: results from the French DIVAT cohort.
abstract: OBJECTIVE
  Contradictory results are reported concerning the influence of anemia on patient and graft survival after renal transplantation. Assuming that level of renal function and anemia are strongly correlated, posttransplantation anemia (PTA) may have a different impact depending on the stage of chronic kidney disease (CKD).
  
  
  METHODS
  This study is a retrospective multicenter analysis using the DIVAT French database. The prevalence, risk factors, and influence of 12-month PTA (World Health Organization's definition) on patient and graft survival were analyzed according to CKD stage (Modification of Diet in Renal Disease equation).
  
  
  RESULTS
  The prevalence of 12-month PTA in our cohort of 4217 patients was 41.1%. Multivariate analysis demonstrated that worse renal function, donor age, period of transplantation, induction therapy, and mTOR inhibitors were significant risk factors for PTA. Posttransplantation anemia was a significant risk factor for all-cause mortality in CKD stages 1 to 2T (hazard ratio, 2.39; 95% confidence interval, 1.99-4.40) and 3T (hazard ratio, 1.52; 95% confidence interval, 1.08-2.15) and for cardiovascular mortality only on CKD stages 1T and 2T. In renal transplant recipients with CKD stages 4 to 5T, patient and graft survival were similar in patients with versus without anemia. Graft survival was not influenced by PTA, whatever the CKD stage.
  
  
  CONCLUSIONS
  Posttransplantation anemia is associated with decreased patient survival only in CKD stages 1T, 2T, and 3T. Posttransplantation anemia has no influence on graft survival regardless of CKD stage.
authors.affiliation: 1 Service de Néphrologie, CHU Lapeyronie, Université de Montpellier, Montpellier, France. 2 Institut de Transplantation et de Recherche en Transplantation, CHU Nantes, RTRS « Centaure », et Inserm U1064, Université de Nantes, Nantes, France. 3 Service de Transplantation Rénale et de Soins Intensifs, Hôpital Necker, Paris, France. 4 Universités Paris Descartes et Sorbonne Paris Cité, Paris, France. 5 Service de Néphrologie et Transplantation Rénale, CHU Brabois, Nancy, France. 6 Service de Néphrologie, HTA, Dialyse et Transplantation d'Organes, CHU Rangueil, Toulouse, France. 7 Université Paul Sabatier, Toulouse, France. 8 Service de Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France. 9 Address correspondence to: Georges Mourad, M.D., Service de Néphrologie, Dialyse et Transplantation, Hôpital Lapeyronie, University of Montpellier, Montpellier 05, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Garrigue
authors.forename: Ilan
authors.initials: I
authors.lastname: Szwarc
authors.forename: Magali
authors.initials: M
authors.lastname: Giral
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Soulillou
authors.forename: Christophe
authors.initials: C
authors.lastname: Legendre
authors.forename: Henri
authors.initials: H
authors.lastname: Kreis
authors.forename: Michele
authors.initials: M
authors.lastname: Kessler
authors.forename: Marc
authors.initials: M
authors.lastname: Ladrière
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Morelon
authors.forename: Fanny
authors.initials: F
authors.lastname: Buron
authors.forename: Pascal
authors.initials: P
authors.lastname: Daguin
authors.forename: Georges
authors.initials: G
authors.lastname: Mourad
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000453:epidemiology / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D006454:Hemoglobins