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Associations of pre‐transplant anemia management with post‐transplant delayed graft function in kidney transplant recipients
Author(s) -
Molnar Miklos Z.,
Kovesdy Csaba P.,
Rosivall Laszlo,
Bunnapradist Suphamai,
Hoshino Junichi,
Streja Elani,
Krishnan Mahesh,
KalantarZadeh Kamyar
Publication year - 2012
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 - 10.1111/j.1399-0012.2012.01598.x
Subject(s) - medicine , odds ratio , hemodialysis , dialysis , transplantation , anemia , hemoglobin , blood transfusion , confidence interval , kidney transplantation , surgery , urology , gastroenterology
Background Delayed graft function ( DGF ) complicates kidney allograft outcomes in the immediate post‐transplantation period. We hypothesized that in hemodialysis patients more severe anemia, iron deficiency, the requirement for higher doses of erythropoietin‐stimulating agents ( ESA ), or blood transfusions prior to transplantation are associated with higher risk of DGF . Methods Linking five‐yr hemodialysis patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, we identified 11 836 hemodialysis patients. Using logistic regression analyses we examined the association between pre‐transplant parameters and post‐transplant DGF . Results Patients were 49 ± 14 (mean ± SD ) yr old and included 38% women, 27% blacks, and 26% diabetics. After adjusting for relevant covariates, pre‐transplant blood transfusion was associated with 33% higher DGF risk (odds ratio [ OR ] = 1.33; 95% confidence interval [ CI ]: 1.19–1.48); and each 5000 U /wk increase of pre‐transplant ESA dose with 5% higher DGF ( OR = 1.05; 95% CI : 1.02–1.09). Compared to pre‐transplant blood hemoglobin of 12–12.99 g/ dL , there was 25% higher risk of DGF with blood hemoglobin 10–10.99 g/ dL ( OR = 1.25; 95% CI : 1.01–1.55), whereas blood hemoglobin ≥13 g/ dL exhibited 15% higher risk of DGF ( OR = 1.15; 95% CI : 0.98–1.34). Conclusions Pre‐transplant blood transfusion, higher ESA dose, and either high or low blood hemoglobin but not iron markers are associated with higher risk of DGF .