Dr. D Sree Bhushan Raju
MD, DM (AIIMS) DNB, FISN, FICP, FIACM, Professor & Head – Department of Nephrology, Nizam’s Institute of Medical Sciences, Hyderabad
Q. How common is anemia following kidney transplant?
A. In routine clinical practice, we come across kidney transplant patients who develop anemia following the procedure. Approximately, about 25% of transplant patients suffer from anemia 6 months following transplantation and this conforms to figures quoted by global studies. Post-transplant anemia is associated with deteriorating quality of life, generalized weakness and fatigue.
Q. What are the risk factors for post-transplant anemia?
A. Lower kidney function, female gender, transferrin saturation below 10%, proteinuria, recurring infections, and underlying conditions such s diabetes mellitus and hypertension are known to precipitate anemia in posttransplant settings. EB virus is known to be associated with severe anemia which has to be screened before transplant itself and it can produce refractory anemia after transplant.
Q. How do you manage post-transplant anemia?
A. Well, in patients with functional allografts, anemia generally resolves within 3-6 months following transplantation. It is imperative that anemia should be treated as anemia could possibly lead to other adverse outcomes, such as impaired cognition, reduced quality of life, and decreased exercise capacity in patients with CKD and ESRD. Another objective is to treat the underlying infection, if any. The aggressiveness of the therapy would be contingent on the physical condition of the patient.
Erythropoietin is hardly used in the management of posttransplant anemia; however, for patients with poor graft function and moderate to severe anemia, erythropoietin is most likely the only efficacious medication available. Folate and Vitamin B12 supplementation are also equally essential.
Erythropoiesis- stimulating agents can be used with great success. ACEIs and ARBs are successfully used to treat post- transplant erythrocytosis. In case drugs like mycophenolate mofetil and azathioprine are in use, they are stopped as they could induce anemia and further aggravate the condition as a consequence of bone marrow suppression.
Q. Does post-transplant anemia alter the prognosis?
A. Yes, post-transplant anemia increases the risk of mortality by 6-10 fold depending on the severity of anemia. As I mentioned earlier, it could also lead to impaired cognition, reduced quality of life and decreased exercise capacity.
Q. What are the challenges in the management of post-transplant anemia?
A. Low initial hemoglobin levels, chronic allograft-related inflammation, ongoing immunosuppressive therapy, and inappropriate therapeutic interventions, result in ongoing challenges in anemia management. Challenges are greater in patients who return to dialysis following transplant.
Q. What are your suggestions to overcome the challenges of post-transplant anemia?
A. Well, to overcome these, appropriate management of the patient right since the beginning is necessary. The patient needs to be tested for hemoglobin levels right since the beginning so that anemia can be detected early and treatment initiated promptly.
