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Published on: September 6, 2017
Risk factors for chronic anemia in pediatric orthotopic liver transplantation: analysis of data from the SPLIT
1Division of Hematology, Oncology & Stem Cell Transplant, Children's Memorial Hospital, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. rliem@childrensmemorial.org
Insights
Chronic anemia affects nearly a quarter of pediatric liver transplant recipients. Key risk factors include gastrointestinal bleeding, leukopenia, and medications like cyclosporine and corticosteroids.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Transplant Medicine
Background:
- Chronic anemia is a common complication in pediatric liver transplant recipients.
- The specific risk factors contributing to post-transplant anemia in this population require further delineation.
Purpose of the Study:
- To identify independent risk factors associated with chronic anemia in children following liver transplantation.
- To inform strategies for managing and potentially preventing anemia in this vulnerable group.
Main Methods:
- Retrospective analysis of data from 1026 pediatric liver transplant recipients transplanted between 2000 and 2008.
- Inclusion criteria required at least two consecutive hemoglobin values between six months and five years post-transplant.
- A multivariate model was employed to determine significant risk factors for chronic anemia.
Main Results:
- Chronic anemia was identified in 23.6% of the study cohort.
- Significant risk factors included gastrointestinal bleeding, leukopenia, use of cyclosporine and corticosteroids, and chronic kidney disease (cGFR <90 mL/min/1.73 m²).
- Antihypertensive medication use was also associated with an increased risk of anemia.
Conclusions:
- Chronic anemia is prevalent in pediatric liver transplant recipients.
- Identifying and addressing modifiable risk factors is crucial for improving outcomes.
- Further research is needed to elucidate the mechanisms underlying these risk factors.
Abstract:
Risk factors for chronic anemia in the post-transplant period have not been clearly delineated in pediatric liver transplant recipients. We analyzed data from children transplanted from 2000 to 2008 with at least two consecutive hemoglobin values from follow-up between six months and five yr post-transplant. A multivariate model was derived to determine independent risk factors associated with chronic anemia. Of 1026 children in this analysis, 242 (23.6%) were found to have chronic anemia. On multivariate analysis, GI bleeding (OR 11.83 [2.08-67.49], p = 0.0054), presence of leukopenia (OR 9.55 [95% CI 3.71-24.62], p < 0.0001), use of cyclosporine (OR 3.69, [95% CI 1.56-8.76], p = 0.0039) and corticosteroids (OR 2.90 [95% CI 1.94-4.33], p < 0.0001), and cGFR <90 mL/min/1.73 m(2) (OR 4.62 [95% CI 2.47-8.67], p < 0.0001) represented the most significant risk factors for chronic anemia. Use of antihypertensive medications (OR 1.89 [95% CI 1.23-2.91], p = 0.0039) was also significantly associated with a higher risk. In summary, chronic anemia is common in children following liver transplant. Our findings underscore the need to define the mechanisms by which these risk factors, some of which are modifiable, result in chronic anemia in pediatric liver transplant recipients.
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