Early-Onset Anemia After Kidney Transplantation Is an Independent Factor for Graft Loss: A Multicenter, Observational Cohort Study

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The association of anemia with outcomes after renal transplantation (RT) is unclear.


We performed a retrospective study that included patients who received a RT in Spain in 2007. We collected data on anemia (hemoglobin [Hb] <11 g/dL and/or erythropoietic agents and/or transfusion in the previous month) as well as transplantation and clinical data during follow-up. We used multivariate Cox models to predict graft and patient survival.


We included 639 patients; 7.2% lost their graft and 6.3% died. The prevalence of anemia was 84% at 7 days, 77% at 1 month, 41% at 2 months, 16% at 12 months, 14% at 24 months, and 18% at 36 months. After adjusting by glomerular filtration rate (hazard ratio [95% confidence interval], 0.96 [0.93–0.98]), low Hb levels at 1 month remained as an independent predictor of graft loss (hazard ratio for each 1 g/dL increase, 0.72 [0.54–0.96]) along with a maximum panel-reactive antibody of more than 10% (3.80 [1.73–8.36]), a donor with stroke (3.30 [1.31–8.28]), and one or more acute rejection episode (13.89 [4.78–40.37]). Tacrolimus use was a protective factor (0.24 [0.11–0.50]).


Low Hb levels in the early posttransplantation period (1 month) seem to be an independent prognostic factor for graft loss, but not for mortality, in Spanish RT patients regardless of graft function, recipient and donor characteristics, unfavorable events within the first month, and immunosuppression.

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