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Kidney Week

Abstract: PO2500

Association Between Elevated Ferritin and Graft Survival During the First Year After Kidney Transplant

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Rozen-zvi, Benaya, Rabin Medical Center, Petah Tikva, Israel
  • 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
Background

Both iron deficiency and iron overload are associated with adverse outcomes in patients with end stage kidney disease on chronic hemodialysis. In contrast, the effect of iron metabolism markers post kidney transplantation have not been thouroughly evaluated. In this study we aimed to evaluate the association between serum ferritin and transferrin saturation during the first year post transplantation on patients and graft survival.

Methods

Retrospective cohort study, using the Rabin Medical Center (RMC) kidney transplant registry . We included adults (>18 years) patients transplanted between 1/1/2006 and 31/12/2017 that had at least one available iron, transferrin and ferritin value during the first year post transplantation. Serum ferritin and transferrin saturation were log transformed and serum ferritin was also analyzed as a dichotomous variable with 500 ng/ml as a cutoff value. Primary outcome was the composite of graft and patients’ survival. Secondary outcomes included death censored graft loss. Univariate and multivariate Cox models were used for the primary composite outcome of patients’ and graft survival.

Results

Seven hundred and twenty-six patients were included in the study, of whom 219 (30.2%) had serum ferritin above 500 mg/dl. Patients with high serum ferritin were older with more diabetes mellitus (DM) and heart disease and tended to have deceased donor transplantation and delayed graft function. By univariate Cox analysis, ferritin level above 500 ng/ml was associated with increased risk of death and graft loss (Hazard Ratio (HR) 2.38, 95% Confidence Interval (CI) 1,69-3.35, p<0.001). By extensive multivariate model ferritin was still highly associated with increased rate of graft loss (HR 1.87, 95% CI 1,29-2.72, p=0.001). High ferritin was also associated with increased risk of the secondary outcome of death censored graft loss (HR 2.09, 95% CI 1,26-3.48, p=0.005). The results were similar when ferritin was evaluated as continuous variable. In contrast, transferrin saturation was not associated with overall and death censored graft survival.

Conclusion

High ferritin during the first year post transplantation was associated with reduced graft survival. Further research is needed to evaluate whether this association is due to inflammation, iron overload or combination of the two.