DENVER—Blood transfusions increase the risk of adverse graft and patient outcomes in anemic renal transplant recipients, but treatment with erythropoiesis-stimulating agents (ESAs) do not, data show.

The findings come from a study by researchers at the University of Minnesota in Minneapolis led by Hassan N. Ibrahim, MD. They analyzed data from 1,520 renal transplant recipients who receive their allografts from 2000 to 2010. Of these patients, 54% had anemia, defined as a hemoglobin level below 12 g/dL. Non-whites, women, those who had pre-transplant dialysis, and patients with previous transplants were more likely to have anemia.

Among anemic recipients not receiving iron, 22.5% received ESAs alone, 37.5% received transfusions alone, 31.4% received both, and 8.9% received neither. In patients receiving iron, the corresponding percentages were 20.8%, 18.1%, 41.6%, and 19.5%.  Members of the cohort without anemia were the reference group and were compared to those treated for anemia. Those who received transfusions alone had a significant twofold increased risk of graft loss and 80% increased risk of death.  Those who received both transfusions and ESAs had a significant 3.5 times increased risk of graft loss and 1.9 times increased risk of death.  Those treated with both iron and ESAs had a significant 2.8 times increased risk of graft loss, but their risk of death was not significantly affected. Patients who received all three treatments (iron, ESAs, and transfusion) had a significant 3.4 and 3.6 times increased risk for graft loss and death, respectively.  In those who received ESAs alone there was no significant difference in the risk of graft loss or death.  This observational data suggests the treatment of post-transplantation anemia warrants further investigation, Dr. Ibrahim said.

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