Anemia After Renal Transplantation Behdad Afzali, MRCP, Salam Al-Khoury, MD, Nilesh Shah, MD, Ashraf Mikhail, MRCP, Adrian Covic, MD, PhD, David Goldsmith, FRCP  American Journal of Kidney Diseases  Volume 48, Issue 4, Pages 519-536 (October 2006) DOI: 10.1053/j.ajkd.2006.07.006 Copyright © 2006 National Kidney Foundation, Inc. Terms and Conditions

Fig 1 Early posttransplantation anemia; evolution of hemoglobin concentrations during the first 12 months in a renal transplant recipient. A patient with a hemoglobin level of 15 g/dL (150 g/L), established on hemodialysis therapy, received a cadaveric single kidney allograft. Erythropoietin therapy (12,000 IU/wk of epoetin alfa) was stopped at transplantation. Graft function was delayed by 3 weeks, during which time dialysis continued. Serum creatinine level reached a plateau at 1.6 mg/dL (142 μmol/L), immediately followed by CMV disease (fever, leukopenia, and CMV direct antigen test positivity) and the use of intravenous ganciclovir. Posttransplantation anemia was severe between weeks 2 and 7 and hemoglobin level did not return to normal until week 26. The patient was not administered EPO during this time. To convert serum creatinine in μmol/L to mg/dL, divide by 88.4; hemoglobin in g/dL to g/L, multiply by 10. American Journal of Kidney Diseases 2006 48, 519-536DOI: (10.1053/j.ajkd.2006.07.006) Copyright © 2006 National Kidney Foundation, Inc. Terms and Conditions

Fig 2 Late posttransplantation anemia; evolution of hemoglobin concentration from 13 to 70 months postengraftment in the same patient as Fig 1. Renal transplant function was stable, with serum creatinine level around 1.6 mg/dL (142 μmol/L) on cyclosporine, AZA, and prednisolone therapy. Hemoglobin level briefly reached 16.3 g/dL (163 g/L; hematocrit, 54%). However, serum creatinine levels slowly deteriorated from 14 to 50 months postengraftment, reaching 2.2 mg/dL (195 μmol/L). A renal biopsy was performed, showing CAN. Cyclosporine therapy was discontinued in favor of sirolimus, started at month 52. Although serum creatinine level improved to 1.8 mg/dL (160 μmol/L), hemoglobin level decreased quickly from 15.5 g/dL (155 g/L) in month 50 to 9.4 g/dL (94 g/L) in month 61. Sirolimus therapy was discontinued at month 61 (because of skin rash, edema, dyslipidemia, and anemia), and MMF was substituted. Only a small increase in hemoglobin levels followed. Iron status was normal throughout. To convert serum creatinine in μmol/L to mg/dL, divide by 88.4; hemoglobin in g/dL to g/L, multiply by 10. American Journal of Kidney Diseases 2006 48, 519-536DOI: (10.1053/j.ajkd.2006.07.006) Copyright © 2006 National Kidney Foundation, Inc. Terms and Conditions