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Anemia after kidney transplantation

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Abstract

Anemia is a frequent complication in pediatric kidney transplant recipients (KTR) with a variable reported prevalence estimated between 20 and 80% depending on how defined. Causes of and risk factors for post-transplantation anemia (PTA) are multifactorial with iron deficiency being the primary cause of early PTA (within the first 6 months after transplantation) and impaired glomerular filtration rate (GFR) commonly responsible for late PTA (after 6 months). Medications, viral infections, chronic inflammation, and comorbidities also play a role. PTA has relevant long-term consequences and is a potential risk factor for allograft dysfunction, cardiovascular morbidity, and mortality. Thus, an anemia evaluation, approximately 3 months post-transplantation, is recommended in order to start early treatment and improve prognosis. Iron status, vitamin B12, folate, markers of hemolysis, and viral PCR should be checked, and medications, in particular combinations of medications, should be carefully evaluated. PTA treatment may be challenging and should be directed to the underlying causes. Iron supplementation and erythropoietin therapy, not extensively used in KTR, may be indicated. Every effort should be made to avoid blood transfusions in the pre-transplant period to avoid allosensitization. Anemia should be corrected to prepare candidates for kidney transplantation in order to reduce the need for perioperative blood transfusions as well.

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  1. Division of Nephrology and Dialysis, Department of Pediatrics, Bambino Gesù Children’s Hospital and Research Institute, Piazza Sant’Onofrio 4, 00165, Rome, Italy

    Isabella Guzzo

  2. Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Meredith A. Atkinson

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  1. Isabella Guzzo
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1. b; 2. d; 3. e; 4. d; 5. a

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Guzzo, I., Atkinson, M.A. Anemia after kidney transplantation. Pediatr Nephrol 38, 3265–3273 (2023). https://doi.org/10.1007/s00467-022-05743-7

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