Post-transplantation anemia is a sign that a patient is at increased risk for graft failure, cardiovascular events, cardiovascular death, and early death, investigators reported at the American Society of Nephrology’s Kidney Week 2021.

In a meta-analysis of 17 studies published 2006 to 2019 involving 16,463 kidney transplant recipients (KTRs), post-transplantation anemia (variably defined but typically hemoglobin less than 13 mg/dL in men and less than 12 mg/dL in women) was significantly associated with a 2.3-fold increased risk for graft failure, investigators led by Poemlarp Mekraksakit, MD, of Texas Tech University Health Sciences Center in Lubbock, Texas, and Wisit Cheungpasitporn, MD, of Mayo Clinic in Rochester, Minnesota confirmed. The investigators further found that anemia in KTRs was significantly associated with a 1.3-, 2.1-, and 1.7-fold increased risk for cardiovascular events, cardiovascular death, and overall mortality, respectively.

Anemia occurring within 6 months of transplant surgery was associated with a 3.0- and 2.6-fold greater risk for graft loss and overall mortality, respectively, compared with no anemia, the investigators reported. Anemia occurring after 6 months was significantly associated with 2.2- and 1.7-fold greater risks, respectively.

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In an interview with Renal & Urology News, the investigators explained:

“It is crucial to find the underlying cause of post-transplantation anemia and to treat it, including using iron for iron deficiency, administering erythropoiesis-stimulating agents (ESAs) to reduce the need for red blood cell transfusions, optimizing immunosuppression, antibiotics, angiotensin converting enzyme inhibitors, angiotensin-receptor blockers, and other medications contributing to anemia, and avoiding unnecessary blood transfusions to reduce the risk for allosensitization and rejection.”

Allograft dysfunction is one of the main risk factors for post-transplantation anemia, they said. Optimizing donor quality and allograft function may help prevent it. It’s also important to minimize nephrotoxic medications and prevent and treat infections.

The team is planning future studies to further define the goal of treatment of post-transplant anemia.


Mekraksakit P, Leelaviwat N, Boonpheng B, et al. Mortality, graft survival, and cardiovascular outcomes in adult kidney transplant recipients with post-transplant anemia: an updated meta-analysis. Presented at: Kidney Week 2021; November 2-7, 2021. Poster: PO2074.