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Transplant Proc. 2019 Jun;51(5):1406-1409. doi: 10.1016/j.transproceed.2019.01.140. Epub 2019 May 3.

Characteristics of Anemia and Iron Deficiency After Kidney Transplant.

Author information

1
Department of Internal Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
2
Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea. Electronic address: godad@hilhospital.com.
3
Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea.
4
Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
5
Department of Surgery, Sungkyunkwan University, Seoul Samsung Medical Center, Seoul, Republic of Korea.
6
Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
7
Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Republic of Korea.
8
Department of Internal Medicine, Keimyung University, Dongsan Medical Center, Daegu, Republic of Korea.

Abstract

BACKGROUND:

Numerous studies have shown that iron deficiency is common in patients with end-stage renal disease. However, change of iron deficiency after kidney transplant (KT) is not fully understood. This study was undertaken to examine sequential changes of iron level after KT.

METHODS:

A total of 1080 KT recipients enrolled in a multicenter observational cohort study between July 2012 and August 2018. A total of 786 patients with transferrin saturation and ferritin level at pretransplant and 1 year after KT were reviewed. Iron deficiency was defined as ferritin <200 ng/mL and total saturation of transferrin (TSAT) < 20%. Anemia was defined as hemoglobin (Hb) < 13 g/dL (male) or <12 g/dL (female).

RESULTS:

Hemoglobin at 1 year after KT was higher than Hb at KT (13.64 [SD, 1.87] g/dL vs 10.53 [SD, 1.63] g/dL; P < .001). The TSAT decreased from baseline at 1 year after KT (33.89% [SD, 18.73%] vs 29.09% [SD, 14.54%]; P < .001), and ferritin level decreased from baseline at 1 year (190.63 [SD, 217.43] ng/mL vs 141.39 [194.25] ng/mL; P < .001). In patients with anemia at pretransplant, the group with anemia at 1 year after KT (persistent group) and the group without anemia at 1 year after KT (improved group) were compared. The persistent group showed higher pretransplant TSAT, lower 1-year TSAT, and lower estimated glomerular filtration rate at 1 year after KT than the improved group. In multivariate analysis, low ferritin at KT, low TSAT at 1 year, and high ferritin at 1 year were the risk factors for low Hb level at 1 year after adjusting multiple variables.

CONCLUSION:

Anemia improved within 1 year after KT, although patients with iron deficiency increased. While ferritin reflected the inflammatory status, low TSAT at 1 year after KT was a risk factor for anemia at 1 year after KT.

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