Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Transplantation. 2012 May 15;93(9):923-8. doi: 10.1097/TP.0b013e31824b36fa.
Posttransplant anemia and its association with transplant outcomes have not been properly studied.
We examined 530 renal allograft recipients transplanted at our center and followed up for 31.0±14.1 months. Hemoglobin (Hb), serum bicarbonate, and creatinine; use of erythropoiesis-stimulating agent (ESA) and iron; and immunosuppressive regimen data were obtained at multiple time points during 24-month posttransplant.
The overall prevalence of anemia was 89.4% at the time of transplant, dropping to 49.2% at 1 year and 44.3% at 2 years. ESA use decreased from 25.6% at 1 month to 8.23% at 24 months, only in 30.9% to 51.2% with severe anemia; 21.0% to 29.2% received iron supplements. Factors independently predictive of Hb included male gender (β=0.64, P<0.001, confidence interval [CI]: 0.45-0.82), estimated glomerular filtration rate (β=0.21 per 10 mL/min/1.73 m, P<0.001; CI: 0.16-0.27), bicarbonate (β=0.4 per 10 mmol/L increase, P<0.001; CI: 0.31-0.85), using angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (β=0.36, P<0.001; CI: 0.16-0.55), African American race (β=-0.34, P=0.001, CI:-0.54 to -0.14), iron (β=-0.28, P=0.003, CI:-0.47 to -0.09) and ESA use (β=-0.73, P<0.001, CI:-0.93 to -0.52), and prednisone (β=-0.46, P<0.001, CI:-0.71 to -0.22 for >10 mg/day vs. none). Using a competing-risk regression model, Hb less than 9 in men and less than 8 in women, was associated with 5.25-fold higher risk of death-censored graft loss compared with no anemia (adjusted, P=0.005, CI: 1.7-16.7). Degree of anemia also remained significantly associated with risk of death (hazard ratio [HR]: 2.2, P<0.1, CI: 0.9-5.6 for grade 2; HR: 3.9, P=0.009, CI: 1.4-10.8 for grade 3; and HR: 4.8, P=0.08, CI: 1.5-15.4 for grade 4, all vs. grade 0).
We showed that posttransplant anemia is common, and ESA/iron use remains suboptimal, and Hb is independently associated with graft failure and mortality.
移植后贫血及其与移植结果的关系尚未得到妥善研究。
我们检查了在我们中心接受移植并随访了 31.0±14.1 个月的 530 名肾移植受者。在移植后 24 个月内的多个时间点获得了血红蛋白（Hb）、血清碳酸氢盐和肌酐；使用促红细胞生成素刺激剂（ESA）和铁；以及免疫抑制方案数据。
移植时总体贫血患病率为 89.4%，1 年时降至 49.2%，2 年时降至 44.3%。ESA 的使用从 1 个月时的 25.6%下降到 24 个月时的 8.23%，仅在 30.9%至 51.2%的患者中出现严重贫血；21.0%至 29.2%的患者接受了铁补充剂。与 Hb 独立相关的因素包括男性（β=0.64，P<0.001，置信区间[CI]：0.45-0.82）、估计肾小球滤过率（β=0.21 每 10 mL/min/1.73 m，P<0.001；CI：0.16-0.27）、碳酸氢盐（β=0.4 每 10 mmol/L 增加，P<0.001；CI：0.31-0.85）、使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（β=0.36，P<0.001；CI：0.16-0.55）、非裔美国人种族（β=-0.34，P=0.001，CI：-0.54 至 -0.14）、铁（β=-0.28，P=0.003，CI：-0.47 至 -0.09）和 ESA 使用（β=-0.73，P<0.001，CI：-0.93 至 -0.52），以及泼尼松（β=-0.46，P<0.001，CI：-0.71 至 -0.22 用于 >10 mg/天 vs. 无泼尼松）。使用竞争风险回归模型，男性 Hb<9 和女性 Hb<8 与无贫血相比，死亡相关移植物丢失的风险高 5.25 倍（调整后，P=0.005，CI：1.7-16.7）。贫血程度与死亡风险也显著相关（风险比[HR]：2.2，P<0.1，CI：0.9-5.6 为 2 级；HR：3.9，P=0.009，CI：1.4-10.8 为 3 级；和 HR：4.8，P=0.08，CI：1.5-15.4 为 4 级，所有级别 vs. 0 级）。
我们表明，移植后贫血很常见，ESA/铁的使用仍然不理想，Hb 与移植物失败和死亡率独立相关。
