Abstract

Background. Although endogenous erythropoietin secretion returns via the renal allograft a few hours following successful engraftment, anemia is a common early or late complication. In addition, anemia is a risk factor for ischemic heart disease and graft loss. We sought to determine risk factors for and the prevalence of severe anemia immediately posttransplantation (PTA). Methods. This cross-sectional retrospective study performed between 2006 and 2009 enrolled 864 adult subjects of mean age 40.7 +/- 13.8 (range = 6-75) years. On the basis of The World Health Organization criteria, a hemoglobin (Hb) level less than 11 g/dL for men and less than 10 g/dL for women was defined as severe anemia. Results. Severe anemia occurred frequently (62.7) among these patients whose most common underlying disease was hypertension 311 (58.2). Their mean Hb level was 9.9 +/- 1.8 g/dL at the time of hospital discharge, namely, almost 2 weeks after transplantation. More than 90 (n = 778) of subjects received a kidney from a living donor. Immediate severe anemia associated with delayed graft function (DGF; P = .01), antithymocyte globulin (ATG)/antilymphocyte globulin (ALG) administration (P = .000), acute rejection (P = .000), recipient gender (P = .000), cold ischemic time (P = .01), pretransplant Hb (P = .000), posttransplant creatinine (P = .001), and acute rejection episodes (P = .000). Upon logistic regression analysis donor age (P = .04, confidence interval CI = 0.7-0.9), recipient female gender (P = .009, CI = 0.08-0.7), and ATG/ALG use (P = .009, CI = 1.7-43.4) showed significant effects to cause severe PTA. Conclusion. Immediate anemia after renal transplantation is a consequence of poor renal function. In addition, ATG/ALG use and DGF can induce severe PTA, which may play roles in ischemic heart disease and graft loss.