Iron Parameters as a Graft Function Indicator in Renal Transplant Recipients

Objective: For those with severe kidney disease, renal transplantation is the best treatment option when compared with dialysis methods; however, it is important to consider potential complications that may occur and the negative effects on graft survival. The aim of this study was to investigate the effects of iron parameters on the development of post-transplant anemia (PTA) and post-transplant erythrocytosis (PTE). Methods: This retrospective study was conducted with 214 renal transplant recipients. PTA was defined as a hemoglobin (Hb) level of 15g/ dL for women. The remaining patients were defined as the control group. Results: PTA developed in 79 patients (36.9%), and PTE developed in 25 patients (11.7%). The iron level was lower in the PTE group before the transplantation and in the first 3 months after transplantation; however, it was also determined that in the PTA group, the iron level was low at 6 and 12 months. Even though the PTA patients’ transferrin saturation (TS) was rose significantly in the first month after transplant, it was observed that the TS was lower in the PTE group at all time points. Conclusion: Even if iron levels are low before kidney transplantation in case of proper replecement is performed and graft functions are intact; anemia may improve and even polycythemia may develop. TS increased in the initial post-transplant period; it may be an early indicator of PTA and the development of graft function failure.

Böbrek Nakli Olan Hastalarda Greft Fonksiyon Göstergesi Olarak Demir Parametreleri

Amaç: Böbrek nakli, diyaliz yöntemlerine kıyasla en iyi tedavi seçeneği olmakla birlikte sonrasında meydana gelen komplikasyonlar greft sağ kalımına olumsuz etkileri nedeniyle önemlidir. Bu çalışmanın amacı, demir parametrelerinin post transplant anemi (PTA) ve post transplant eritrositoz (PTE) gelişimi üzerine etkilerini araştırmaktır. Gereç ve Yöntem: Bu retrospektif çalışmamıza böbrek nakli yapılmış 214 hasta dahil edildi. Nakil sonrası altıncı aydan sonra bakılan hemoglobin düzeyleri ortalaması erkeklerde 15 g/dL üstünde olan hastalar PTE; geri kalan tüm hastalar da kontrol grubu olarak tanımlandı. Bulgular: İki yüz on dört hastanın 79’unda (%36.9) PTA, 25’inde (%11.7) PTE geliştiği görüldü. Demir düzeylerinin nakil öncesinde ve nakil sonrası ilk üç ayda PTE grubunda düşük tespit edilmesine rağmen altıncı ve 12. ayda PTA grubunda düşüş gösterdiği tespit edildi. Transferrin satürasyonlarına (TS) ise nakil sonrası birinci ayda PTA grubunda anlamlı olarak yükselmesine rağmen, diğer tüm aylarda PTE hastalarında düşük seyrettiği tespit edildi. Sonuç: Böbrek nakli yapılmadan önce demir düzeyi düşük olsa dahi uygun replasman yapıldığı takdirde greft fonksiyonları sağlamsa eğer anemi düzelecek hatta polisitemi dahi gelişebilecektir. Nakil sonrası erken dönemde transferrin satürasyonları yükseliyorsa PTA’nın habercisi dolayısıyla greft fonksiyon bozukluğu gelişebileceğinin erken göstergesi olabilir.

Kaynakça

1. Vanrenterghem Y, Ponticelli C, Morales JM, Abramowicz D, Baboolal K, Eklund B, et al. Prevalence and management of anemia in renal transplant recipients: a European survey. Am J Transplant 2003;3:835–45.

2. Unal A, Sipahioglu MH, Akcakaya M, Tokgoz B, Sav T, Oymak O, et al. An underappreciated problem in renal transplant recipients: anemia. Transplant Proc 2008;40:1399–403.

3. Gaston RS, Julian BA, Curtis JJ. Posttransplant erythrocytosis: an enigma revisited. Am J Kidney Dis 1994;24:1–11.

4. Danovitch GM, Jamgotchian NJ, Eggena PH, Paul W, Barrett JD, Wilkinson A, et al. Angiotensin-converting enzyme inhibition in the treatment of renal transplant erythrocytosis. Clinical experience and observation of mechanism. Transplantation 1995;60:132–7.

5. Muirhead N. Erythropoietin and renal transplantation. Kidney Int Suppl 1999;69:S86–92.

6. Foley RN, Parfrey PS, Morgan J, Barré PE, Campbell P, Cartier P, et al. Effect of hemoglobin levels in hemodialysis patients with asymptomatic cardiomyopathy. Kidney Int 2000;58:1325–35.

7. Teruel JL, Lamas S, Vila T, Hernandez RM, Quereda C, Marcen R, et al. Serum ferritin levels after renal transplantation: a prospective study. Nephron 1989;51:462–5.

8. Miles AM, Markell MS, Daskalakis P, Sumrani NB, Hong J, Sommer BG, et al. Anemia following renal transplantation: erythropoietin response and iron deficiency. Clin Transplant 1997;11:313–5.

9. Moore LW, Smith SO, Winsett RP, Acchiardo SR, Gaber AO. Factors affecting erythropoietin production and correction of anemia in kidney transplant recipients. Clin Transplant 1994;8:358–64.

10. Zheng S, Coyne DW, Joist H, Schuessler R, Godboldo-Brooks A, Ercole P, et al. Iron deficiency anemia and iron losses after renal transplantation. Transpl Int 2009;22:434–40.

11. Drüeke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, Burger HU, et al; CREATE Investigators. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 2006;355:2071–84.

12. Saito S, Fujiwara T, Sakagami K, Matsuno T, Tanaka N. Anemia following renal transplantation. Transplant Proc 1998 ve 3025, 30.

13. Winkelmayer WC, Chandraker A, Alan Brookhart M, Kramar R, Sunder-Plassmann G. A prospective study of anaemia and long-term outcomes in kidney transplant recipients. Nephrol Dial Transplant 2006;21:3559–66.

14. Wickre CG, Norman DJ, Bennison A, Barry JM, Bennett WM. Postrenal transplant erythrocytosis: a review of 53 patients. Kidney Int 1983;23:731–7.

15. Kessler M, Hestin D, Mayeux D, Mertes PM, Renoult E. Factors predisposing to post-renal transplant erythrocytosis. A prospective matched-pair control study. Clin Nephrol 1996;45:83–9.

Kaynak Göster

Southern Clinics of Istanbul Eurasia
  • ISSN: 2587-0998
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2017

1.1b385