Premium
Erythropoiesis and renal transplant pregnancy
Author(s) -
Magee Laura A,
Von Dadelszen Peter,
Darley John,
Beguin Yves
Publication year - 2000
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1034/j.1399-0012.2000.140205.x
Subject(s) - medicine , creatinine , pregnancy , erythropoiesis , transplantation , endocrinology , gastroenterology , retrospective cohort study , anemia , genetics , biology
Objective. To examine erythropoiesis in renal transplant pregnancies.
Methods. Retrospective cohort study of 30 renal transplant cases and 30 age, smoking and parity‐matched healthy controls with normal index pregnancy. Retrospective chart review and assay of frozen antenatal serum (for serum erythropoietin concentration [serum EPO]), transferrin receptor protein [TfR], ferritin, folate and B12) were performed. The linear regression equation for normal pregnancy controls was used to calculate predicted [serum EPO] and the observed/predicted (O/P) log [serum EPO] was plotted. The relationship between [serum EPO] and haemoglobin (Hb) among transplant cases was considered to be different from that among controls if the slope of the O/P log [serum EPO] versus Hb regression was significantly different from zero.
Results. The transplant (14 cadaveric) to conception interval was (median [range]) 33.5 [4, 189] months. Immunosuppressants were azathioprine (n=25), cyclosporine (n=22) and/or prednisone (n=25). Cases were more often primiparous (20 vs. 7 [controls]; p=0.01), had pre‐existent hypertension (20 vs. 0 [controls]; p<0.001), developed new/increased hypertension or pre‐eclampsia (28 vs. 0 [controls]; p<0.001) and an antenatal rise in creatinine (14 vs. 2 [controls]; p<0.001). In early pregnancy, cases had similar EPO (15.2 [2.6, 84.6] vs. 15.7 [6.4, 41.0] [controls] U/L) but lower Hb (101 [65, 129] vs. 116 [106, 150] g/L; p<0.001). Twenty‐two (73%) cases had Hb<100 g/L (vs. 4 [controls]; p<0.0001); Hb was comparable at 6 wk postpartum. With advancing gestational age (GA), Hb remained stable and serum EPO increased in both groups. The slope of the O/P log [serum EPO] versus Hb for transplant cases was significantly different from zero within both the 17–28 wk (slope±SEM: 0.010±0.002; p<0.0001) and the 29–42 wk GA categories (0.006±0.003; p=0.02). Cases showed smaller rises in serum TfR (change 481 [−1 471, 2 780]) vs. 1119 [−698, 4 195] [controls] ng/mL; p=0.005).
Conclusions. Anaemia frequently complicates renal transplant pregnancies, in which serum EPO is inappropriately low and the rate of erythropoiesis blunted.