Posttransplantation anemia: mechanisms and management

Treatment of anemia in patients with chronic kidney disease is a topic of increasing interest and controversy. However, anemia in the kidney transplant recipient has received relatively little attention in the literature despite the reported high prevalence of 30% to 40%. The pathogenesis of anemia among kidney transplant recipients is usually multifactorial, including compromised graft function, iron deficiency, immunosuppressive and other medications, and an inflammatory state causing erythropoietin resistance. It is unclear whether posttransplantation anemia is causally linked to cardiovascular events and mortality. Clinicians should screen kidney transplant recipients for posttransplantation anemia and carefully weigh the potential risks and benefits of treatment on an individual basis until well-designed, prospective studies provide further insight. This article reviews the prevalence, pathogenesis, and management of anemia in kidney transplant recipients.