Chhabra Darshika, Grafals Monica, Skaro Anton I, Parker Michele, Gallon Lorenzo
Nephrology/Transplantation, Northwestern University, Chicago, IL 60611, USA.
Clin J Am Soc Nephrol. 2008 Jul;3(4):1168-74. doi: 10.2215/CJN.04641007. Epub 2008 May 7.
The impact of posttransplantation anemia on patient survival, renal allograft survival, and rate of acute rejection is not known.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A total of 1023 patients who underwent kidney transplantation at one center from January 1992 through June 2003 were retrospectively analyzed. Posttransplantation anemia was defined as mean hemoglobin <11 g/dl after 3 mo after transplantation. Data on demographics, pretransplantation dialysis, previous transplant history, pretransplantation hemoglobin, degree of HLA mismatch, and donor characteristics were collected. Some of the posttransplantation data that were collected in addition to the hemoglobin included delayed graft function; diabetes; hypertension; induction and maintenance of immunosuppressive regimen; posttransplantation infections; and use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, statins, aspirin, and beta blockers. Cox regression models were used to assess the effects of posttransplantation anemia on each outcome: Mortality, graft survival, and rate of acute rejection. Median follow-up time was 4 yr.
During the entire follow-up period, there were 89 (9%) deaths, 143 (14%) acute rejection episodes, and 235 (23%) kidney losses. In multivariate Cox regression models, being anemic after transplantation, after the first 90 d, was associated with increased overall mortality and increased renal allograft loss. Posttransplantation anemia was also associated with increased acute rejection rates.
This study shows that posttransplantation anemia is associated with worse patient and graft survival and higher rates of acute rejection when compared with nonanemic renal transplant recipients.
移植后贫血对患者生存率、肾移植存活率及急性排斥反应发生率的影响尚不清楚。
设计、地点、参与者及测量方法：对1992年1月至2003年6月在一个中心接受肾移植的1023例患者进行回顾性分析。移植后贫血定义为移植后3个月平均血红蛋白<11 g/dl。收集了人口统计学数据、移植前透析情况、既往移植史、移植前血红蛋白、HLA错配程度及供体特征。除血红蛋白外，还收集了一些移植后数据，包括移植肾功能延迟恢复；糖尿病；高血压；免疫抑制方案的诱导和维持；移植后感染；以及血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、他汀类药物、阿司匹林和β受体阻滞剂的使用情况。采用Cox回归模型评估移植后贫血对各结局的影响：死亡率、移植存活率和急性排斥反应发生率。中位随访时间为4年。
在整个随访期间，有89例（9%）死亡，143例（14%）发生急性排斥反应，235例（23%）肾移植失功。在多变量Cox回归模型中，移植后前90天之后出现贫血与总体死亡率增加和肾移植丢失增加相关。移植后贫血还与急性排斥反应发生率增加相关。
本研究表明，与非贫血肾移植受者相比，移植后贫血与患者和移植存活率较差以及急性排斥反应发生率较高相关。
