Associations of pre-transplant anemia management with post-transplant delayed graft function in kidney transplant recipients

Miklos Z. Molnar, Csaba P. Kovesdy, Laszlo Rosivall, Suphamai Bunnapradist, Junichi Hoshino, Elani Streja, Mahesh Krishnan, Kamyar Kalantar-Zadeh

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3 Citations (Scopus)


Background: Delayed graft function (DGF) complicates kidney allograft outcomes in the immediate post-transplantation period. We hypothesized that in hemodialysis patients more severe anemia, iron deficiency, the requirement for higher doses of erythropoietin-stimulating agents (ESA), or blood transfusions prior to transplantation are associated with higher risk of DGF. Methods: Linking five-yr hemodialysis patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, we identified 11 836 hemodialysis patients. Using logistic regression analyses we examined the association between pre-transplant parameters and post-transplant DGF. Results: Patients were 49 ± 14 (mean ± SD) yr old and included 38% women, 27% blacks, and 26% diabetics. After adjusting for relevant covariates, pre-transplant blood transfusion was associated with 33% higher DGF risk (odds ratio [OR] = 1.33; 95% confidence interval [CI]: 1.19-1.48); and each 5000 U/wk increase of pre-transplant ESA dose with 5% higher DGF (OR = 1.05; 95% CI: 1.02-1.09). Compared to pre-transplant blood hemoglobin of 12-12.99 g/dL, there was 25% higher risk of DGF with blood hemoglobin 10-10.99 g/dL (OR = 1.25; 95% CI: 1.01-1.55), whereas blood hemoglobin ≥13 g/dL exhibited 15% higher risk of DGF (OR = 1.15; 95% CI: 0.98-1.34). Conclusions: Pre-transplant blood transfusion, higher ESA dose, and either high or low blood hemoglobin but not iron markers are associated with higher risk of DGF.

Original languageEnglish
Pages (from-to)782-791
Number of pages10
JournalClinical Transplantation
Issue number5
Publication statusPublished - Sep 1 2012



  • Anemia
  • Blood product transfusion
  • Delayed graft function
  • Iron deficiency
  • Iron saturation ratio
  • Kidney transplantation
  • Pre-transplant treatment
  • Recombinant human erythropoietin treatment
  • Serum ferritin

ASJC Scopus subject areas

  • Transplantation

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