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Prevalence, Etiologies, and Long-Term Impact of Early and Late Post-Transplant Anemia in Pediatric Kidney Transplant
Hamdi Cucan1, Songul Yilmaz2, Dilara Besli Celik2
1Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
Insights
Post-transplant anemia (PTA) is common in pediatric kidney transplant recipients, often linked to iron deficiency. Early identification and management of iron status are crucial for improving graft function and long-term outcomes.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Hematology
Background:
- Anemia is a frequent complication post-pediatric kidney transplant, potentially impacting graft function and outcomes.
- Limited data exists on post-transplant anemia (PTA) in children, necessitating further investigation.
- This study addresses the prevalence, causes, and long-term effects of PTA on kidney function in pediatric recipients.
Purpose of the Study:
- To investigate the prevalence and causative factors of post-transplant anemia (PTA) in pediatric kidney transplant recipients.
- To evaluate the long-term effects of anemia on graft function and clinical outcomes in this population.
- To identify modifiable risk factors for PTA, such as pre-transplant iron status.
Main Methods:
- Retrospective analysis of 68 pediatric kidney transplant recipients followed for at least 6 months.
- Collection of demographic, clinical, and laboratory data, classifying PTA as early or late.
- Assessment of associations between PTA, iron status, graft function (eGFR, creatinine), and other complications.
Main Results:
- Early PTA occurred in 57.4% of patients, primarily due to iron deficiency; 28.2% became chronic.
- Older age, pre-transplant iron deficiency, and low transferrin saturation were linked to early PTA.
- Anemia at follow-up was associated with lower eGFR, higher creatinine, proteinuria, hyperparathyroidism, and rejection.
Conclusions:
- Post-transplant anemia is frequent in pediatric kidney transplant recipients, with iron deficiency being a primary cause for both early and late PTA.
- Pre-transplant iron status is a critical, modifiable risk factor for developing PTA.
- Persistent anemia necessitates comprehensive evaluation and close monitoring of graft function to prevent adverse outcomes.
Background:
Anemia is a frequent complication in pediatric kidney transplant recipients and may adversely affect graft functions and long-term outcomes. However, data on post-transplant anemia (PTA) in children remain limited. The aim of this study was to investigate the prevalence and causative factors of PTA and the long-term effects of anemia on kidney functions in pediatric patients.
Methods:
This retrospective study included 68 pediatric kidney transplant recipients followed for at least 6 months at a tertiary referral center. Demographic, clinical, and laboratory data were collected from medical records. PTA was classified as early or late.
Results:
Early PTA was observed in 57.4% of the patients, primarily due to iron deficiency, and 28.2% of these cases became chronic. Older age at transplantation, pre-transplant presence of iron deficiency, and lower transferrin saturation levels were significantly associated with early PTA. At the 6th month, patients with early PTA had lower hemoglobin, lower estimated glomerular filtration rate (eGFR), and higher creatinine levels. Late PTA developed in 52.9% of the patients and was mostly due to iron deficiency, chronic kidney dysfunction, and rejection. At the final visit, patients with anemia had significantly lower eGFR, higher creatinine, and more frequent proteinuria and hyperparathyroidism. Left ventricular hypertrophy regressed markedly after transplantation and was not associated with anemia at follow-up.
Conclusions:
Anemia was frequently encountered after pediatric kidney transplantation. Both early and late PTA were strongly linked to iron deficiency. Pre-transplant iron status emerged as a key modifiable risk factor. Anemia was associated with graft dysfunction, proteinuria, hyperparathyroidism, and rejection. In particular, patients with persistent anemia should undergo a comprehensive evaluation for potential etiological factors and be closely monitored with respect to graft functions.
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