Anemia after kidney transplantation may increase the risk of graft loss, cardiovascular events, and death from cardiovascular and other causes, investigators report.

Poemlarp Mekraksakit, MD, of Texas Tech University Health Sciences Center in Lubbock, Texas, and colleagues conducted a systematic review and meta-analysis of 17 studies published from August 2006 to April 2019 including 16,463 kidney transplant recipients. In line with previous research, post-transplant anemia was significantly associated with a 2.3-fold increased risk of graft loss and a 1.7-fold increased risk of all-cause mortality. In a novel finding, anemia occurring within 6 months of transplantation carried greater risks of graft loss (2.96- vs 2.22-fold increased risk) and all-cause mortality (2.63- vs 1.73-fold increased risk) compared with anemia that occurred later, the investigators reported in Progress in Transplantation.

The meta-analysis further found that post-transplant anemia was significantly associated with a 1.3-fold increased risk of major adverse cardiovascular events and a 2.1-fold increased risk of cardiovascular death compared with no anemia.

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As post-transplant anemia has myriad causes, prompt assessment and appropriate management is crucial, according to Dr Mekraksakit’s team.

Post-transplant anemia can be prevented by routine assessment of iron stores in the post-transplant period for prompt recognition of iron deficiency and optimizing immunosuppression, antibiotics, ACE inhibitors, angiotensin receptor blockers, and other medications contributing to anemia, they stated. “Other principals to prevent and treat anemia include optimizing donor quality and allograft function, minimizing nephrotoxic medications, and preventing and treating infections.”

As included studies were observational, the investigators cautioned that the relationship between post-transplant anemia and adverse outcomes such as death might be directly attributable to the specific cause, such as allograft dysfunction or overimmunosuppression.


Mekraksakit P, Leelaviwat N, Benjanuwattra J, et al. A systematic review and meta-analysis of posttransplant anemia with overall mortality and cardiovascular outcomes among kidney transplant recipients. Prog Transplant. 2023 Jan 2:15269248221145046. doi:10.1177/15269248221145046