López Oliva María Ovidia, Del Castillo Caba Domingo, Fernández Fresnedo Gema
Servicio de Nefrología, Hospital La Paz, Madrid.
Nefrologia. 2009;29 Suppl 1:25-30. doi: 10.3265/NEFROLOGIA.2009.29.S.1.5634.EN.FULL.
The definition of anemia is established by the World Health Organization and was subsequently adopted by the American Society of Transplantation, which defines anemia as hemoglobin concentration <12 g/dl in women and <13 g/dl in men. PREVALENCE OF ANEMIA POSTTRANSPLANTATION: Varies throughout the posttransplantation period and is associated with the degree of renal graft function. The relationship between hemoglobin levels and glomerular filtration does not behave the same way as in the population with chronic kidney disease. The results of various studies show a high prevalence in the first months after transplantation (<6 months), which decreases from the first year posttransplantation and then increases related to loss of graft function. European study on the management of anemia showed a prevalence of anemia in 38.6% and only 18% of patients with severe anemia were treated with erythropoietin (EPO).
There is a decrease in the synthesis of erythropoietin (EPO) or an increase in resistance to EPO. There are many factors that can cause anemia post-transplantation. Some of these factors are specific to transplanted patients whilst others are common to all patients with chronic kidney disease. Among the common factors there are: the degree of renal function and iron deficiency and among the factors of transplantation there are acute rejection, post-transplantation medications, infections and malignancies.
The available data evaluating the association of anemia with morbidity and mortality of the patient and graft survival are scarce. Most studies are retrospective and analyze experiences of individual centers. They showed a higher mortality and morbidity among patients with a hemoglobin <11 g/dl. (Evidence B). TREATMENT OF POST-TRANSPLANTATION ANEMIA: Erythropoiesis-stimulating agents (ESA) and replenishment of iron deposits (Evidence A). RESPONSE TO TREATMENT: In transplant patients there may be some resistance to treatment with erythropoiesis- stimulating agents (ESA) due to the use of myelosuppressive medications, chronic inflammation and other factors. - Adverse effects of treatment with ESA: There are few controlled studies failed to show respect to the ESA that are effective and unlikely to accelerate the deterioration of renal function but may aggravate hypertension.
贫血的定义由世界卫生组织确定，随后被美国移植学会采用，该学会将贫血定义为女性血红蛋白浓度<12 g/dl，男性血红蛋白浓度<13 g/dl。移植后贫血的患病率：在整个移植后期间有所不同，且与肾移植功能的程度相关。血红蛋白水平与肾小球滤过之间的关系与慢性肾脏病患者群体中的情况不同。各种研究结果显示，移植后最初几个月（<6个月）患病率较高，从移植后第一年开始下降，然后随着移植功能丧失而增加。一项关于贫血管理的欧洲研究表明，贫血患病率为38.6%，仅有18%的重度贫血患者接受了促红细胞生成素（EPO）治疗。
促红细胞生成素（EPO）合成减少或对EPO的抵抗增加。有许多因素可导致移植后贫血。其中一些因素是移植患者特有的，而其他因素则是所有慢性肾脏病患者共有的。常见因素包括：肾功能程度和缺铁；移植相关因素包括急性排斥反应、移植后用药、感染和恶性肿瘤。
评估贫血与患者发病率、死亡率以及移植物存活之间关联的现有数据很少。大多数研究是回顾性的，分析的是各个中心的经验。这些研究表明，血红蛋白<11 g/dl的患者死亡率和发病率较高。（证据等级B）。移植后贫血的治疗：促红细胞生成素刺激剂（ESA）和补充铁储备（证据等级A）。治疗反应：由于使用骨髓抑制药物、慢性炎症和其他因素，移植患者对促红细胞生成素刺激剂（ESA）治疗可能存在一定抵抗。 - ESA治疗的不良反应：很少有对照研究表明ESA有效且不太可能加速肾功能恶化，但可能会加重高血压。
