Associations of pre-transplant anemia management with post-transplant delayed graft function in kidney transplant recipients

Miklos Z. Molnar, Csaba Kovesdy, Laszlo Rosivall, Suphamai Bunnapradist, Junichi Hoshino, Elani Streja, Mahesh Krishnan, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Delayed graft function (DGF) complicates kidney allograft outcomes in the immediate post-transplantation period. We hypothesized that in hemodialysis patients more severe anemia, iron deficiency, the requirement for higher doses of erythropoietin-stimulating agents (ESA), or blood transfusions prior to transplantation are associated with higher risk of DGF. Methods: Linking five-yr hemodialysis patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, we identified 11 836 hemodialysis patients. Using logistic regression analyses we examined the association between pre-transplant parameters and post-transplant DGF. Results: Patients were 49 ± 14 (mean ± SD) yr old and included 38% women, 27% blacks, and 26% diabetics. After adjusting for relevant covariates, pre-transplant blood transfusion was associated with 33% higher DGF risk (odds ratio [OR] = 1.33; 95% confidence interval [CI]: 1.19-1.48); and each 5000 U/wk increase of pre-transplant ESA dose with 5% higher DGF (OR = 1.05; 95% CI: 1.02-1.09). Compared to pre-transplant blood hemoglobin of 12-12.99 g/dL, there was 25% higher risk of DGF with blood hemoglobin 10-10.99 g/dL (OR = 1.25; 95% CI: 1.01-1.55), whereas blood hemoglobin ≥13 g/dL exhibited 15% higher risk of DGF (OR = 1.15; 95% CI: 0.98-1.34). Conclusions: Pre-transplant blood transfusion, higher ESA dose, and either high or low blood hemoglobin but not iron markers are associated with higher risk of DGF.

Original languageEnglish (US)
Pages (from-to)782-791
Number of pages10
JournalClinical Transplantation
Volume26
Issue number5
DOIs
StatePublished - Sep 2012
Externally publishedYes

Fingerprint

Delayed Graft Function
Anemia
Transplants
Kidney
Odds Ratio
Hemoglobins
Erythropoietin
Blood Transfusion
Confidence Intervals
Renal Dialysis
Transplantation
Iron-Deficiency Anemias
Transplant Recipients
Allografts
Registries
Dialysis
Iron
Logistic Models
Regression Analysis
Organizations

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Associations of pre-transplant anemia management with post-transplant delayed graft function in kidney transplant recipients. / Molnar, Miklos Z.; Kovesdy, Csaba; Rosivall, Laszlo; Bunnapradist, Suphamai; Hoshino, Junichi; Streja, Elani; Krishnan, Mahesh; Kalantar-Zadeh, Kamyar.

In: Clinical Transplantation, Vol. 26, No. 5, 09.2012, p. 782-791.

Research output: Contribution to journalArticle

Molnar, Miklos Z. ; Kovesdy, Csaba ; Rosivall, Laszlo ; Bunnapradist, Suphamai ; Hoshino, Junichi ; Streja, Elani ; Krishnan, Mahesh ; Kalantar-Zadeh, Kamyar. / Associations of pre-transplant anemia management with post-transplant delayed graft function in kidney transplant recipients. In: Clinical Transplantation. 2012 ; Vol. 26, No. 5. pp. 782-791.
@article{94ac3b9f4e24450d8bef0116a82829cd,
title = "Associations of pre-transplant anemia management with post-transplant delayed graft function in kidney transplant recipients",
abstract = "Background: Delayed graft function (DGF) complicates kidney allograft outcomes in the immediate post-transplantation period. We hypothesized that in hemodialysis patients more severe anemia, iron deficiency, the requirement for higher doses of erythropoietin-stimulating agents (ESA), or blood transfusions prior to transplantation are associated with higher risk of DGF. Methods: Linking five-yr hemodialysis patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, we identified 11 836 hemodialysis patients. Using logistic regression analyses we examined the association between pre-transplant parameters and post-transplant DGF. Results: Patients were 49 ± 14 (mean ± SD) yr old and included 38{\%} women, 27{\%} blacks, and 26{\%} diabetics. After adjusting for relevant covariates, pre-transplant blood transfusion was associated with 33{\%} higher DGF risk (odds ratio [OR] = 1.33; 95{\%} confidence interval [CI]: 1.19-1.48); and each 5000 U/wk increase of pre-transplant ESA dose with 5{\%} higher DGF (OR = 1.05; 95{\%} CI: 1.02-1.09). Compared to pre-transplant blood hemoglobin of 12-12.99 g/dL, there was 25{\%} higher risk of DGF with blood hemoglobin 10-10.99 g/dL (OR = 1.25; 95{\%} CI: 1.01-1.55), whereas blood hemoglobin ≥13 g/dL exhibited 15{\%} higher risk of DGF (OR = 1.15; 95{\%} CI: 0.98-1.34). Conclusions: Pre-transplant blood transfusion, higher ESA dose, and either high or low blood hemoglobin but not iron markers are associated with higher risk of DGF.",
author = "Molnar, {Miklos Z.} and Csaba Kovesdy and Laszlo Rosivall and Suphamai Bunnapradist and Junichi Hoshino and Elani Streja and Mahesh Krishnan and Kamyar Kalantar-Zadeh",
year = "2012",
month = "9",
doi = "10.1111/j.1399-0012.2012.01598.x",
language = "English (US)",
volume = "26",
pages = "782--791",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",
number = "5",

}

TY - JOUR

T1 - Associations of pre-transplant anemia management with post-transplant delayed graft function in kidney transplant recipients

AU - Molnar, Miklos Z.

AU - Kovesdy, Csaba

AU - Rosivall, Laszlo

AU - Bunnapradist, Suphamai

AU - Hoshino, Junichi

AU - Streja, Elani

AU - Krishnan, Mahesh

AU - Kalantar-Zadeh, Kamyar

PY - 2012/9

Y1 - 2012/9

N2 - Background: Delayed graft function (DGF) complicates kidney allograft outcomes in the immediate post-transplantation period. We hypothesized that in hemodialysis patients more severe anemia, iron deficiency, the requirement for higher doses of erythropoietin-stimulating agents (ESA), or blood transfusions prior to transplantation are associated with higher risk of DGF. Methods: Linking five-yr hemodialysis patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, we identified 11 836 hemodialysis patients. Using logistic regression analyses we examined the association between pre-transplant parameters and post-transplant DGF. Results: Patients were 49 ± 14 (mean ± SD) yr old and included 38% women, 27% blacks, and 26% diabetics. After adjusting for relevant covariates, pre-transplant blood transfusion was associated with 33% higher DGF risk (odds ratio [OR] = 1.33; 95% confidence interval [CI]: 1.19-1.48); and each 5000 U/wk increase of pre-transplant ESA dose with 5% higher DGF (OR = 1.05; 95% CI: 1.02-1.09). Compared to pre-transplant blood hemoglobin of 12-12.99 g/dL, there was 25% higher risk of DGF with blood hemoglobin 10-10.99 g/dL (OR = 1.25; 95% CI: 1.01-1.55), whereas blood hemoglobin ≥13 g/dL exhibited 15% higher risk of DGF (OR = 1.15; 95% CI: 0.98-1.34). Conclusions: Pre-transplant blood transfusion, higher ESA dose, and either high or low blood hemoglobin but not iron markers are associated with higher risk of DGF.

AB - Background: Delayed graft function (DGF) complicates kidney allograft outcomes in the immediate post-transplantation period. We hypothesized that in hemodialysis patients more severe anemia, iron deficiency, the requirement for higher doses of erythropoietin-stimulating agents (ESA), or blood transfusions prior to transplantation are associated with higher risk of DGF. Methods: Linking five-yr hemodialysis patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, we identified 11 836 hemodialysis patients. Using logistic regression analyses we examined the association between pre-transplant parameters and post-transplant DGF. Results: Patients were 49 ± 14 (mean ± SD) yr old and included 38% women, 27% blacks, and 26% diabetics. After adjusting for relevant covariates, pre-transplant blood transfusion was associated with 33% higher DGF risk (odds ratio [OR] = 1.33; 95% confidence interval [CI]: 1.19-1.48); and each 5000 U/wk increase of pre-transplant ESA dose with 5% higher DGF (OR = 1.05; 95% CI: 1.02-1.09). Compared to pre-transplant blood hemoglobin of 12-12.99 g/dL, there was 25% higher risk of DGF with blood hemoglobin 10-10.99 g/dL (OR = 1.25; 95% CI: 1.01-1.55), whereas blood hemoglobin ≥13 g/dL exhibited 15% higher risk of DGF (OR = 1.15; 95% CI: 0.98-1.34). Conclusions: Pre-transplant blood transfusion, higher ESA dose, and either high or low blood hemoglobin but not iron markers are associated with higher risk of DGF.

UR - http://www.scopus.com/inward/record.url?scp=84867634496&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84867634496&partnerID=8YFLogxK

U2 - 10.1111/j.1399-0012.2012.01598.x

DO - 10.1111/j.1399-0012.2012.01598.x

M3 - Article

VL - 26

SP - 782

EP - 791

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

IS - 5

ER -