Medicine A, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
BMC Nephrol. 2019 Feb 13;20(1):51. doi: 10.1186/s12882-019-1244-y.
Post transplantation anemia (PTA) is common among kidney transplant patients. PTA is associated with increased graft loss and in most studies with increased mortality. However, the effect of the severity of anemia on this associations was not thoroughly evaluated.
Patients who underwent kidney transplantation in Rabin Medical Center (RMC) were included in the study. Data were collected during the years 2002-2016. Anemia was defined as hemoglobin (Hb) level less than 12 g/dL in women and less than 13 g/dL in men, in accordance with World Health Organization (WHO) criteria. Severe anemia was defined as hemoglobin lower than 11 g/dL. Primary outcome was a composite of patient and graft survival. We used univariate and multivariate models to evaluate association between severity and specific causes of anemia with the outcomes. As the risk associated with anemia changed over time we analyzed the risk separately for the early and the late period (before and after 1251 days).
Our cohort included 1139 patients, 412 (36.2%) of which had PTA and 134 (11.7%) had severe anemia. On multivariable analysis, severe anemia was highly associated with the primary outcome at the early period (HR 6.26, 95% CI 3.74-10.5, p < 0.001). Anemia due to either AKI & acute rejection (11.9% of patients) or infection (16.7%), were associated with primary outcome at the early period (HR 9.32, 95% CI 5.3-26.41, p < 0.001 and HR 3.99, 95% CI 2.01-7.95, p < 0.001, respectively). There was non-significant trend for association between anemia due to Nutritional deficiencies (29.1%) and this outcome (HR 3.07, 95% CI 0.93-10.17, p = 0.067).
PTA is associated with graft loss and mortality especially during the first three years. Anemia severity affects this association. An anemia workup is recommended for PTA.
肾移植患者常发生移植后贫血（PTA）。PTA 与移植物丢失增加有关，在大多数研究中与死亡率增加有关。然而，贫血严重程度对这些关联的影响尚未得到充分评估。
本研究纳入了在拉宾医学中心（RMC）接受肾移植的患者。数据收集于 2002 年至 2016 年。根据世界卫生组织（WHO）标准，贫血定义为女性血红蛋白（Hb）水平<12g/dL，男性<13g/dL。严重贫血定义为血红蛋白<11g/dL。主要结局为患者和移植物存活率的复合结局。我们使用单变量和多变量模型来评估贫血严重程度与结局之间的关系。由于贫血相关风险随时间而变化，我们分别分析了早期和晚期（1251 天之前和之后）的风险。
我们的队列包括 1139 名患者，其中 412 名（36.2%）患有 PTA，134 名（11.7%）患有严重贫血。多变量分析显示，严重贫血与早期的主要结局高度相关（HR 6.26，95%CI 3.74-10.5，p<0.001）。因急性肾损伤和急性排斥反应（患者的 11.9%）或感染（16.7%）引起的贫血与早期的主要结局相关（HR 9.32，95%CI 5.3-26.41，p<0.001 和 HR 3.99，95%CI 2.01-7.95，p<0.001，分别）。因营养缺乏（29.1%）引起的贫血与该结局之间存在非显著趋势（HR 3.07，95%CI 0.93-10.17，p=0.067）。
PTA 与移植物丢失和死亡率有关，特别是在头三年内。贫血严重程度影响这种关联。建议对 PTA 进行贫血检查。
