Pretransplant ESA Hyporesponsiveness May Worsen Post-Transplant Outcomes

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PHILADELPHIA—Two research teams have found that hyporesponsiveness to erythropoiesis stimulating agents (ESAs) prior to renal transplantation is associated with a higher risk of post-transplant allograft failure and mortality, according to study findings presented at Kidney Week 2011.

In two studies of 9,281 hemodialysis (HD) patients who underwent their first kidney transplant,

Miklos Z. Molnar, MD, PhD, of the Harbor-UCLA Medical Center in Torrance, Calif., and colleagues demonstrated that patients in the second, third, and fourth quartiles of ESA responsiveness—as measured using an ESA responsiveness index calculated by dividing ESA dose by hemoglobin values—had a twofold increased risk of death-censored graft failure and a 1.7, 2.2, and 2.4 times increased risk of graft-censored death compared with those in the first quartile, after adjusting for potential confounders.

In addition, in a study of 36,450 renal transplant patients who had at least six months of HD prior to the transplant date, Nadiesda A. Costa, MD, and colleagues at the University of North Carolina at Chapel Hill found that patients who exhibited hyporesponsiveness to ESAs—defined as three consecutive months with a monthly ESA dose of 75,000 units or higher—had a 62% increased risk of allograft loss and an 86% increased risk of death from any cause at six months post-transplant in adjusted analyses. The investigators concluded that ESA response during dialysis may be used to identify high-risk renal transplant patients before and after transplantation.

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