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Abstract: SA-PO053

Post Transplantation Anemia: Causes, Severity and Their Association with Graft and Patient Survival

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical


  • Schechter, Amir, Rabin Medical Center, Petah Tikva, Israel
  • Rahamimov, Ruth, Rabin Medical Center, Petah Tikva, Israel
  • Gafter-Gvili, Anat, Rabin Medical Center, Petah Tikva, Israel
  • Rozen-zvi, Benaya, Rabin Medical Center, Petah Tikva, Israel

Post transplantation anemia (PTA) is common among kidney transplant patients. PTA is associated with increased graft loss and in most studies with increased mortality. We aimed to evaluate association of PTA its severity and specific causes with late outcomes.


Patients who underwent kidney transplantation in Rabin Medical Center (RMC). Data were collected from the kidney transplant registry during the years 2002-2016. Anemia was defined in accordance with World Health Organization (WHO) criteria, severe anemia was defined as hemoglobin lower than 11 g/dL. We evaluated all separate anemia events during the follow-up period, for each event a full laboratory workup was collected. Specific causes for each anemia episode were documented (acute rejection, acute kidney injury [AKI], infection and nutritional deficiencies). Primary outcome was a composite of patient and graft survival. We used univariate and multivariate time varying Cox models to evaluate association between severity and specific causes of anemia to the outcomes.


Our cohort included 1139 patients, out of which 412 (36.2%) had PTA during the follow-up period. Distribution of causes of anemia were acute rejection and/or AKI (11.9%), infections (16.7%), hematological disorders, bleeding or hemolysis (9%) and nutritional deficiencies (29.1%). No obvious reason was found in 137 patients (33.3%). On multivariable analyses, the anemia group was significantly associated with a composite of graft loss and mortality, (HR 2.063, 95% CI 1.542-2.761, p<0.001), and with each outcome separately. Severe anemia was significantly associated with graft loss and mortality combined (HR 4.362, 95% CI 3.035-6.270, p<0.001) and separately. A weaker association was found between mild anemia and graft loss, but not with mortality. Causes of anemia: AKI & acute rejection (HR 5.570, 95% CI 3.784-8.198, p<0.001), infectious (HR 2.483, 95% CI 1.536-4.016, p<0.001) and nutritional deficiencies (HR 1.882, 95% CI 1.203-2.942, p=0.006) were all associated with graft loss or mortality.


PTA is associated with graft loss and mortality. Anemia severity and etiology affects this association. An anemia workup is recommended for PTA.