TY - JOUR
T1 - The interaction between post-transplant anemia and allograft function in kidney transplantation
T2 - The Japan Academic Consortium of Kidney Transplantation-II study
AU - The Japan Academic Consortium of Kidney Transplantation (JACK)
AU - Okumi, Masayoshi
AU - Okabe, Yasuhiro
AU - Unagami, Kohei
AU - Kakuta, Yoichi
AU - Iizuka, Junpei
AU - Takagi, Toshio
AU - Shirakawa, Hiroki
AU - Shimizu, Tomokazu
AU - Omoto, Kazuya
AU - Ishida, Hideki
AU - Nakamura, Masafumi
AU - Tanabe, Kazunari
N1 - Funding Information:
We appreciate the support from Katsunori Shimada, Ph.D. (STATZ Institute, Inc., Tokyo, Japan), who provided expert assistance with statistical analyses.
Publisher Copyright:
© 2019, Japanese Society of Nephrology.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Background: The interaction between post-transplant anemia (PTA) and allograft function in kidney transplantation has not been evaluated directly. PTA, defined by WHO/AST criteria, was investigated in 1307 adult kidney transplant recipients between 2000 and 2015 (median follow-up, 7 years). Methods: We investigated the impact of hemoglobin (Hb) on graft failure (non-censored for death) and their interactions, time-dependent Cox model, and subgroup analysis were used. Results: PTA prevalence was 43.6% at 7 years and varied according to allograft function, recipient sex, and follow-up period. Decreased Hb considering the time-varying effect was associated with an increased risk of graft failure (hazard ratio = 1.83, 95% CI 1.66–2.02, P < 0.001). In subgroup analysis, allograft function (post-transplant time-averaged estimated glomerular filtration rate and cut point: 45 mL/min/1.73 m2) had significant interaction (P = 0.032). The 7-year graft failure rate in recipients with PTA and high eGFR was 7.7% (HR 1.52, 95% CI 1.25–1.84), whereas in those with PTA and low eGFR was 19.9% (HR 2.00, 95% CI 1.74–2.31). Conclusions: The unfavorable impact of PTA was significantly enhanced by low allograft function. PTA is likely to be associated with graft failure due to interaction with allograft function. Therefore, we should consider both Hb level and allograft function while determining the treatment strategy.
AB - Background: The interaction between post-transplant anemia (PTA) and allograft function in kidney transplantation has not been evaluated directly. PTA, defined by WHO/AST criteria, was investigated in 1307 adult kidney transplant recipients between 2000 and 2015 (median follow-up, 7 years). Methods: We investigated the impact of hemoglobin (Hb) on graft failure (non-censored for death) and their interactions, time-dependent Cox model, and subgroup analysis were used. Results: PTA prevalence was 43.6% at 7 years and varied according to allograft function, recipient sex, and follow-up period. Decreased Hb considering the time-varying effect was associated with an increased risk of graft failure (hazard ratio = 1.83, 95% CI 1.66–2.02, P < 0.001). In subgroup analysis, allograft function (post-transplant time-averaged estimated glomerular filtration rate and cut point: 45 mL/min/1.73 m2) had significant interaction (P = 0.032). The 7-year graft failure rate in recipients with PTA and high eGFR was 7.7% (HR 1.52, 95% CI 1.25–1.84), whereas in those with PTA and low eGFR was 19.9% (HR 2.00, 95% CI 1.74–2.31). Conclusions: The unfavorable impact of PTA was significantly enhanced by low allograft function. PTA is likely to be associated with graft failure due to interaction with allograft function. Therefore, we should consider both Hb level and allograft function while determining the treatment strategy.
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U2 - 10.1007/s10157-019-01737-2
DO - 10.1007/s10157-019-01737-2
M3 - Article
C2 - 31020441
AN - SCOPUS:85064839738
SN - 1342-1751
VL - 23
SP - 1066
EP - 1075
JO - Clinical and Experimental Nephrology
JF - Clinical and Experimental Nephrology
IS - 8
ER -