Kidney Week

Abstract: TH-PO958

Impact of Immediate Post-Transplant Parenteral Iron Therapy on Prevalence of Anemia and Short-Term Allograft Function in a Cohort of Pediatric Renal Transplant Recipients

Session Information

• Live Donor Outcomes and Kidney Transplantation in Pediatric and Ethnic/Racial Groups
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Transplantation

• 1702 Transplantation: Clinical and Translational

Authors

• Bamgbola, Oluwatoyin F., SUNY Downstate Medical Center, Brooklyn, New York, United States

Oluwatoyin F. Bamgbola,

• Aviles, Diego H., Louisiana State University Health Science Center, New Orleans, Louisiana, United States

Diego H. Aviles,

• Iorember, Franca M, Phoenix Children''s Hospital, Scottsdale, Arizona, United States

Franca M Iorember,

Background

Anemia is common but under-diagnosed and is often inadequately treated in renal transplant {KTX} recipients. Due to high turn over rate during chronic dialysis and blood loss during KTX surgery, iron deficiency (ID) is the major determinant of early-onset (< 6 mo) post-transplant anemia (PTA). We sought to examine the clinical benefit of routine use of parenteral (IV) iron in patients who had KTX surgery.

Methods

Subjects aged 2 -18 yrs who had KTX between 2011 & 2015 received 1-2 mg/kg of diluted iron sucrose over 1 hr in the first week of surgery. Historical control was their counterparts between 2005 & 2010. We determined i) the prevalence rate (PR) and predictors of early- (6 mo) and late-onset (12 mo) anemia, ii) relationship between IV iron therapy and anemia; and iii) association of IV iron treatment with the rates of acute rejection (ARE), allograft dysfunction, infection, erythropoietin (EPO) use and hospitalization (HOS).

Results

Prevalence rate of anemia for the cohort (n = 79): 85% at 1 mo, 74% at 3 mo, 55% at 6 mo, 60% at 12 mo & 47% at 24 mo. There was greater PR of anemia at 3 (p = 0.01), 6 (p = 0.03) and 12 mos. (p = 0.03) in the Controls (n = 42). The best set of predictors in multiple regression analysis for early anemia were poor donor quality and no IV iron treatment; R² = 0.13; p = 0.01. Predictors for late-anemia at 12 mo: anemia at 6 mo, steroid use, allograft, previous KTX, and no IV iron treatment (p = 0.001). Although not significant, there was greater frequency of allograft dysfunction, ARE, and hospitalization in the Controls. There was greater number of anemia treated with EPO rescue in the Controls (p = 0.03).

Conclusion

- Post-surgery treatment with IV iron reduces the rate of anemia up to 12 mo after KTX
- Post-surgery IV iron use reduced the need for later EPO rescue treatment for anemia
- Early anemia is predominantly due to iron deficiency and poor donor quality
- Late anemia is due to pre-existing anemia, steroid use, previous KTX and allograft dysfunction
- Literatures support association of early and late anemia with lower graft and patient survival
- Randomized controlled trials are needed to determine the scope of evaluation for PTA and cost benefit analysis of therapeutic options including EPO, oral iron and/ or IV iron