Impact of pre-transplant anaemia correction and erythropoietin resistance on long-term graft survival

Background. This study investigated whether recombinant human erythropoietin (rHuEPO)-hyporesponsive anaemia before transplantation is associated with a poorer graft outcome and lower patient survival. Methods. A total of 15 051 kidney transplant recipients, with a minimum follow-up of 1 year, were...

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Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 2005-09, Vol.20 (suppl-8), p.viii8-viii12
Main Authors: Campise, Mariarosaria, Mikhail, Ashraf, Quaschning, Thomas, Snyder, Jon, Collins, Allan
Format: Article
Language:English
Subjects:
Adult
Aged
aggressive treatment
anaemia
Anemia - drug therapy
Drug Resistance
Erythropoietin - therapeutic use
Female
graft failure
Graft Survival
Humans
Kidney Transplantation
Male
Middle Aged
patient survival
post-transplant patients
Recombinant Proteins
rHuEPO hyporesponsiveness
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Summary:Background. This study investigated whether recombinant human erythropoietin (rHuEPO)-hyporesponsive anaemia before transplantation is associated with a poorer graft outcome and lower patient survival. Methods. A total of 15 051 kidney transplant recipients, with a minimum follow-up of 1 year, were stratified as either rHuEPO hyporesponsive or rHuEPO responsive (using a threshold rHuEPO-treated haemoglobin level of 11 g/dl). They were followed for a median of 24 months. Outcomes included times from transplantation to graft failure (including patient death), return to dialysis or pre-emptive re-transplantation, and death with a functioning graft. Results. The cumulative incidence of graft failure was 50% for rHuEPO-hyporesponsive patients, compared with 41.7% for rHuEPO responders (P = 0.0091). Among rHuEPO-hyporesponsive patients, 41.7% returned to dialysis or underwent a pre-emptive re-transplantation, compared with 32% of rHuEPO responders (P = 0.0091). Death with a functioning graft occurred in 16.9% of rHuEPO-hyporesponsive and in 15% of rHuEPO-responsive patients (P = 0.3949). Conclusions. The results showed higher mortality and higher incidence of graft failure at 5 years for rHuEPO-hyporesponsive patients. It is unclear whether anaemia treatment per se or treatment of more severe co-morbidity resulting in hyporesponsiveness to anaemia treatment may be causally linked to reduced renal transplant outcomes.
ISSN:0931-0509
1460-2385
DOI:10.1093/ndt/gfh1110