COMPLICATIONS - CARDIOVASCULAR

E. Toronyi¹, R. Chmel², K. Földes¹, S. Török¹, M. Varga¹, E. Sárváry¹, R. Langer^1
1Transplantation And Surgical, Semmelweis University, Budapest/HUNGARY, ²Transplantation And Surgical Department, Semmelweis University, Budapest/HUNGARY

Body: Introduction: Anaemia is a severe complication after transplantation and carries increased mortality. The effect of different erythropoietin’s is not always sufficient and great fluctuation of haemoglobin level could be observed. The use of continuous erythropoietin stimulating agents (CERA) can bring a solution for the maintenance of the constant haemoglobin level. We analysed the efficacy of methoxy polyethilen glycol epoetin beta (Mircera), which is a CERA product among 1300 kidney transplanted patients at our Department. Methods: In our retrospective study 264(34%) patients out of 1300 were treated with methoxy polyethilen glycol epoetin beta. 153 were females and 111 were males. Posttransplantation anaemia was defined as mean haemoglobin level< 11 g/dl. Average age at the time of transplantation was 45 ±14 years. The time elapsed between transplantation and the first treatment with CERA was 71,64 ±58,02 months. To assess the efficacy of treatment we measured the haemoglobin, haematocrit, hypochrom red blood cells, kidney function .The number of administration, doses and time of CERA treatments was documented. Results:264 patients received 1495 injections, the average number of injections was 5, 66 per patient. The patients were divided into 2 groups according to their serum creatinine level, below 210µmol/l and between 210- 400 µmol/l. Patients with better kidney function required smaller doses than patients with worse kidney function, the difference was significant. (Female: 616,96±10,29 vs. 693,75±567,73µg, male: 523,77±522,42 µg vs. 597,43 ±597,41 µg.). We found a correlation between total doses of Mircera and the time since transplantation. In females, if the time since transplantation was below the average 79 months, the doses were 600,27±506,05 vs. In case of longer than 79 months time 659,76±546,63 µg. The average time elapse since transplantation in male was 92 months. In cases of shorter than this time the total doses were 452,77±494,46 vs. 591,66±565,25 µg in patients with longer than 92 months since transplantation. We also found correlation between the time from transplantation until the first treatment with CERA and the total required doses of Mircera. The highest doses were needed in patients whose treatment was started 3-6 years after transplantation. In female the average total doses was 828,12±591,29 µg, in male 776,92± 720,34µg. The haemoglobin level increased parallel with the doses of given erythropoietin. Conclusion: Anaemia is common among kidney transplanted patients and there is correlation between anaemia and kidney graft function. The later the anaemia became manifest the more difficult was its correction and the required amount of erythropoietin was higher. It is not known what pathomechanism is acting in the kidney until the anaemia becomes manifest. We can suppose the effect of energy malnutrition and chronic microimflammation. It seems that, if the time for the effect of these pathomechanism is shorter, the amount of erythropoietin needed for correction of anaemia is less. In case of longer manifestation time the required doses is also higher. According to our observation a prospective study would be needed to determine the dynamics of erythropoietin synthesis in the transplanted kidney in correlation with the kidney function and the time since transplantation.

Disclosure: All authors have declared no conflicts of interest.