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Published on: April 12, 2021
Anemia after kidney transplantation
Isabella Guzzo1, Meredith A Atkinson2
1Division of Nephrology and Dialysis, Department of Pediatrics, Bambino Gesù Children's Hospital and Research Institute, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
Insights
Post-transplantation anemia (PTA) affects many pediatric kidney transplant recipients. Early evaluation and treatment targeting causes like iron deficiency are crucial for better outcomes.
Area of Science:
- Nephrology
- Pediatric Transplantation
- Hematology
Background:
- Anemia is a common complication in pediatric kidney transplant recipients (KTR), with prevalence ranging from 20-80%.
- Causes are multifactorial, including iron deficiency (early PTA) and impaired glomerular filtration rate (GFR) (late PTA).
- Post-transplantation anemia (PTA) is linked to adverse outcomes like allograft dysfunction, cardiovascular issues, and mortality.
Purpose of the Study:
- To highlight the significance of anemia evaluation in pediatric KTR.
- To emphasize early detection and management of PTA to improve prognosis.
- To discuss the causes, risk factors, and treatment strategies for PTA.
Main Methods:
- Review of factors contributing to anemia in pediatric KTR.
- Discussion of recommended diagnostic evaluations around 3 months post-transplantation.
- Evaluation of treatment options, including iron supplementation and erythropoietin therapy.
Main Results:
- Iron deficiency is the primary cause of early PTA, while impaired GFR often causes late PTA.
- Medications, viral infections, inflammation, and comorbidities also contribute to PTA.
- Anemia evaluation should include iron status, vitamin B12, folate, hemolysis markers, and viral PCR.
Conclusions:
- Anemia evaluation approximately 3 months post-transplantation is recommended for early treatment and improved prognosis.
- Treatment should address underlying causes, with iron supplementation and erythropoietin therapy as potential options.
- Optimizing anemia status before transplantation is vital to reduce perioperative transfusion needs and avoid allosensitization.
Abstract:
Anemia is a frequent complication in pediatric kidney transplant recipients (KTR) with a variable reported prevalence estimated between 20 and 80% depending on how defined. Causes of and risk factors for post-transplantation anemia (PTA) are multifactorial with iron deficiency being the primary cause of early PTA (within the first 6 months after transplantation) and impaired glomerular filtration rate (GFR) commonly responsible for late PTA (after 6 months). Medications, viral infections, chronic inflammation, and comorbidities also play a role. PTA has relevant long-term consequences and is a potential risk factor for allograft dysfunction, cardiovascular morbidity, and mortality. Thus, an anemia evaluation, approximately 3 months post-transplantation, is recommended in order to start early treatment and improve prognosis. Iron status, vitamin B12, folate, markers of hemolysis, and viral PCR should be checked, and medications, in particular combinations of medications, should be carefully evaluated. PTA treatment may be challenging and should be directed to the underlying causes. Iron supplementation and erythropoietin therapy, not extensively used in KTR, may be indicated. Every effort should be made to avoid blood transfusions in the pre-transplant period to avoid allosensitization. Anemia should be corrected to prepare candidates for kidney transplantation in order to reduce the need for perioperative blood transfusions as well.
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