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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.

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Department of Internal Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea. Electronic address:
Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
Department of Surgery, Sungkyunkwan University, Seoul Samsung Medical Center, Seoul, Republic of Korea.
Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Republic of Korea.
Department of Internal Medicine, Keimyung University, Dongsan Medical Center, Daegu, Republic of Korea.



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.


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).


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.


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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