The possible role of early post-transplant inflammation in later anemia in kidney transplant recipients

Abstract

Delayed kidney graft function and acute rejection in the early post-transplant period affect both short and long-term allograft survival. Allograft rejection, as an inflammatory state, results in increased erythropoietin resistance, which leads to decreased haemoglobin (Hb) level. We conducted this study to evaluate whether inflammation in the early post-transplant period could predict later anemia. This is a retrospective cohort study based on the analysis of 64 existing clinical records. Predictor: White blood cells (WBC) count obtained by the end of the first week post-transplant (W1). Covariates: Donor's age, recipient's age and sex. Outcome: Anemia identified at 12 months (M12) post engraftment. Median WBC count at W1 was 9,5 × 103/μL (5th - 95th percentile 5,2 ×10 3/μL -17,8 × 03/μL). Mean Hb values at M 12 were 129,9 ± 20,3 g/L, in males 136,2 ± 20,1 g/L and in females 119,4 ± 16,2 g/L. The significant correlation was found between WBC at W1 and Hb at M12. Pearson coefficient of correlation r was -0,26, and 95% confidence interval (CI) for r was -0,47 to -0,015 (p=0,03). Univariate logistic regression showed significant association between WBC at W1 and Hb at M12 (OR 1,20; 95% CI 1,04 to i,39, p=0,0i). After the adjustment for donor's and recipient's age by transplantation and recipient's sex, multiple regression showed that WBC count remained predictive of anemia at M12 (OR 1,17; 95% CI 1,01 to 1,36, p=0,03). Early post-transplant inflammatory response predicts later anemia in kidney transplant recipients. An increase in WBC count in the first week post-transplant by 109/L increases the risk for anemia after twelve months by 17%.