Delayed Graft Function Risk Not Lowered with High-Dose EPO
PHILADELPHIA—Short-term treatment with high-dose erythropoietin (EPO)—which is known to have tissue protective effects—does not decrease the incidence or duration of delayed graft function (DGF) or primary non-function (PNF) in recipients of kidneys from non-heart-beating donors, but it is associated with significantly better and faster renal recovery, a study found.
The double-blind, placebo-controlled study, by a team at Leiden University Medical Center in Leiden, The Netherlands, included 92 renal transplant recipients who received organs from non-heart-beating donors. Those assigned to the EPO group received erythropoietin-beta as an intravenous bolus of 3.3 × 104 IU starting three to four hours before transplantation. The standard immunosuppressive regimen consisted of prophylaxis with an interleukin-2 receptor antagonist, delayed introduction of a calcineurin inhibitor (cyclosporine), mycophenolate mofetil, and steroids.
DGF occurred in 39 of the 45 recipients in the EPO treated group (86.7%) and 41 of the 47 patients in the placebo group (87.2%), Johan W. De Fijter, MD, PhD, Professor of Nephrology, reported at the 2011 American Transplant Congress. The incidence of PNF was 6.7% in the EPO group (three patients) and 2.1% in the placebo group (one patient). If DGF developed, the median duration was 10 days in the EPO group and nine days in the placebo group. Acute rejections occurred in 20.5% in the EPO group and in 26.1 % in the placebo group. None of the differences between the groups was significant.
The measured creatinine clearance was not significantly different between the study arms at six weeks (44 mL/min and 46 mL/min in EPO and placebo groups, respectively), but it was significantly higher in the EPO group one year after transplantation (68 vs. 57 mL/min).
One-year patient and graft survival in the EPO and placebo group were 93% and 96% in the EPO and placebo group, respectively.
EPO treatment also was associated with a higher rate of thromboembolic events, which at one year occurred in 11 EPO-treated patients versus only three placebo recipients.