Anemia After Kidney Transplantation – Is the Incidence Increasing?

Prior to the availability of recombinant erythropoietin, virtually all kidney transplant recipients exhibited some degree of anemia in the early post-transplant period, primarily as the consequence of operative blood loss and postoperative phlebotomies superimposed on a preexisting state of hypoerthyropoiesis characteristic of renal failure. Restoration of endogenous erythropoietin secretion by the renal allograft, now known to occur within hours to days after transplantation (1), generally led to correction of anemia within a period of 3–8 months (2), at least in patients with well-functioning grafts. Interestingly, widespread use of recombinant erythropoietin in patients awaiting kidney transplantation has not entirely eliminated the problem of early post-transplant anemia (less than 6 months after transplantation). Recent longitudinal studies in adults (3) and children (4) indicate that the prevalence of anemia at the time of renal transplantation ranges between 41% and 67%, respectively. In addition to perioperative blood losses, other factors contributing to early post-transplant anemia include iron deficiency, the persistent effort of uremic toxins, and the negative effects of immunosuppression on erythropoiesis.