Safety and Efficiency of Recombinant Human Erythropoietin Treatment in Anemic Pregnant Women with a Kidney Transplant

Prof. Dr. hab. med. F. Kokot, Department of Nephrology, Silesian School of Medicine, Francuska Street 20, 40-027 Katowice (Poland) Dear Sir, Severe anemia due to erythropoietin (EPO) deficiency is one of the main symptoms of chronic renal failure. Successful kidney transplantation is followed by normalization of uremic anemia or even transient poly-cythemia. There is some evidence that this last phenomenon is due to EPO production by the transplant and native kidneys. Successful kidney transplantation is usually followed by normalization of function of the pituitary-go-nadal axis and an improvement in fertility [1]. In dialysis patients the conception rate is less than 1 among 200 females and increases to 1 in 50 women after successful kidney transplantation [2]. In pregnant kidney transplant women immunosuppressive therapy may be a potential factor for severe anemia. We report the results of recombinant human EPO (rHuEPO) therapy in 2 pregnant kidney transplant patients with severe anemia of unknown origin. Two women, 19 and 21 years old, with end-stage renal failure caused by chronic pyelonephritis had been hemodialyzed for 69 and 9 months, respectively, when they underwent renal cadaveric transplantation. Immediately after kidney transplantation both patients were treated by prednisone and aza-thioprine, and later 1 of them was converted to prednisone and cyclosporin A. Graft function was excellent in both patients, and plasma creatinine levels oscillated between 106-162 and 126-141 μmol/l, respectively. In 1 patient moderate anemia developed in spite of a normal plasma iron level (23.4 μmol/l) and ferritin (210 ng/ml). The Hct value ranged from 25 to 32%, and the Hb level from 7.1 to 9.0 g/dl. In spite of normal plasma iron and ferritin concentrations, oral iron therapy was started together with folic acid. This treatment was only partially successful (increase in the Hct value to 32%). Six months after transplantation early pregnancy was diagnosed. Since that moment the patient was carefully monitored by a nephrologist and also an obstetrician. Immunosuppressive therapy consisted of prednisone (7.5 mg/day) and azathioprine (2 mg/kg body mass/day). During the whole gestation period graft function was normal. Ultrasound examinations of the fetus at 22, 24, 30 and 35 weeks of gestation revealed normal development. In spite of iron and folic acid supplementation aggravation of the already diagnosed anemia was observed. At the 10th week of gestation the Hb level was 7.1 g/dl and the Hct value 24%, while the ferritin level was 180 ng/ml. This was the