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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2013  |  Volume : 24  |  Issue : 2  |  Page : 367-369
Author's reply


Assistant Professor, Division of Nephrology, Ain-Shams University, Cairo, Egypt

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Date of Web Publication26-Mar-2013
 

How to cite this article:
Sany D. Author's reply. Saudi J Kidney Dis Transpl 2013;24:367-9

How to cite this URL:
Sany D. Author's reply. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2019 Nov 13];24:367-9. Available from: http://www.sjkdt.org/text.asp?2013/24/2/367/109606
To the Editor,

First, we thank Dr. Zohreh Rostami for his interest in reading and commenting on our manuscript entitled "Prevalence and association of post-renal transplant anemia." Whenever an original paper deserves such a letter, authors are happy and honored to give their opinions. Many studies pointed out the prevalence of post-transplant anemia (PTA) in developed countries. A Japanese study concluded that the prevalence of PTA is 20%, [1] and a big multicenter study conducted in 72 centers in 16 European countries [Transplant European Survey on Anemia Management (TRESAM)] concluded that the prevalence of PTA was 38.6%. [2] In a published British study, the prevalence of anemia was 53% at 12 months from the kidney transplantation. [3] A Turkish study concluded that prevalence of PTA was 49.3%, [4] and in Austria, PTA was present in 39.7%. [5] Among Hungarians, PTA was present in 33.8%. [6] In our study, [7] the prevalence of anemia was 45% at six months after transplantation. Zohreh Rostami et al found a high prevalence of PTA (53%) among 2713 adult renal transplant recipients (RTRs), and the prevalence of severe anemia (according to the World Health Organization criteria, a hemoglobin level of less than 11 g/dL for men and less than 10 g/dL for women was defined as severe anemia) was 24%. [8] This large variability is at least partly explained by differences in diagnostic criteria of anemia, age, race, and interval since transplantation. Current research is mainly focused on anemia, persisting three to six months after transplantation, with a distinction made between early (between three and six months) and late (more than six months) PTA. Less is known about the prevalence and pathophysiology of anemia within the first three months after renal transplantation (further referred to as immediate PTA), especially in the developing countries. Our study demonstrated that high serum creatinine level, female gender, delayed graft function, acute rejection, and infection were the only independent risk factors for anemia in early renal transplant. Renal dysfunction is strongly associated with the development of PTA [2] and considered as a major risk factor; other factors such as rejection, [9],[10] recent infection, [11],[12],[13],[14] longer duration of transplantation, [15] immunosuppressive treatments, [3],[16],[17],[18],[19],[20],[21],[22],[23] use of angiotensin converting enzyme inhibitors/angiotensin receptors blockers (ACEI/ARB), [2],[24],[25] low serum albumin, [4] protein energy waste syndrome, [26] and old age of the kidney donor [2] are all considered as risk factors for the development of PTA. We feel that it would be more appropriate for questions to be addressed by a future study, with sufficient number of patients, different age groups, different races, and with different contributing factors to provide clear guidelines for management of anemia post renal transplant.

 
   References Top

1.Saito S, Fujiwara T, Sakagami K, Matsuno T, Tanaka N. Anemia following renal transplan-tation. Transplant Proc 1998;30:3025-6.  Back to cited text no. 1
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2.Vanrenterghem Y, Ponticelli C, Morales JM, et al. Prevalence and management of anemia in renal transplant recipients: A European survey. Am J Transplant 2003;3:835-45.  Back to cited text no. 2
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3.Borrows R, Loucaidou M, Chusney G, et al. Anaemia and congestive heart failure early post-renal transplantation. Nephrol Dial Transplant 2008;23:1728-34.  Back to cited text no. 3
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4.Unal A, Sipahioglu MH, Akcakaya M, et al. An underappreciated problem in renal transplant recipients: Anemia. Transplant Proc 2008;40:1399-403.  Back to cited text no. 4
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5.Lorenz M, Kletzmayr J, Perschl A, Furrer A, Horl WH, Sunder-Plassmann G. Anemia and iron deficiencies among long-term renal transplant recipients. J Am Soc Nephrol 2002;13: 794-7.  Back to cited text no. 5
    
6.Molnar MZ, Czira M, Ambrus C, et al. Anemia is associated with mortality in kidney-transplanted patients-a prospective cohort study. Am J Transplant 2007;7:818-24.  Back to cited text no. 6
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7.Elsayed H, Sany D, Eldin EN, El-shahawy Y, Shawki S, Aziz A. Prevalence and association of post-renal transplant anemia. Saudi J Kidney Dis Transpl 2012;23:461-6.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.Rostami Z, Einollahi B. The risk factors of anemia after kidney transplantation. Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, I.R. Iran.   Back to cited text no. 8
    
9.Moulin B, Ollier J, George F, et al. Serum erythropoietin and reticulocyte maturity index after renal transplantation: A prospective longitudinal study. Nephron 1995;69:259-66.  Back to cited text no. 9
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10.Chua MS, Barry C, Chen X, Salvatierra O, Sarwal MM. Molecular profiling of anemia in acute renal allograft rejection using DNA microarrays. Am J Transplant 2003;3:17-22.  Back to cited text no. 10
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11.Kumar V, Gupta S, Singh S, Goyal VK, Yadav M. Pure red cell aplasia associated with cytomegalovirus infection. J Pediatr Hematol Oncol 2010;32:315-6.  Back to cited text no. 11
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12.So BJ, Chae KM, Lee KK, Lee YJ, Jeong BH. Pure red cell aplasia due to parvovirus B19 infection in a renal transplant patient: A case report. Transplant Proc 2000;32:1954-6.  Back to cited text no. 12
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13.Vales-Albertos LJ, Garcia-Cardenas M, Chavez-Becerra S, Gomez-Navarro B, Monteon-Ramos F, Cueto-Manzano AM. Pure red cell aplasia associated with parvovirus B19 infection in renal transplantation: The first case report in Mexico. Transplantation 2005;79:739.  Back to cited text no. 13
    
14.Karras A, Thervet E, Legendre C. Hemophagocytic syndrome in renal transplant recipients: Report of 17 cases and review of literature. Transplantation 2004;77:238-43.  Back to cited text no. 14
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15.Yorgin PD, Scandling JD, Belson A, Sanchez J, Alexander SR, Andreoni KA. Late post-transplant anemia in adult renal transplant recipients. An under-recognized problem? Am J Transplant 2002;2:429-35.  Back to cited text no. 15
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16.Kuypers DR, de Jonge H, Naesens M, et al. Current target ranges of mycophenolic acid exposure and drug-related adverse events: A 5-year, open-label, prospective,clinical follow-up study in renal allograft recipients. Clin Ther 2008;30:673-83.  Back to cited text no. 16
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17.Engelen W, Verpooten GA, Van der Planken M, Helbert MF, Bosmans JL, De Broe ME. Four cases of red blood cell aplasia in association with the use of mycophenolate mofetil in renal transplant patients. Clin Nephrol 2003; 60:119-24.  Back to cited text no. 17
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18.Ourahma S, Mercadal L, Tezenas du Montcel S, et al. Anemia in the period immediately following renal transplantation. Transplant Proc 2007;39:1446-50.  Back to cited text no. 18
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19.Geiger C, Foller M, Herrlinger KR, Lang F. Azathioprine-induced suicidal erythrocyte death. Inflamm Bowel Dis 2008;14:1027-32.  Back to cited text no. 19
    
20.Rigatto C. Anemia, renal transplantation, and the anemia paradox. Semin Nephrol 2006;26: 307-12.  Back to cited text no. 20
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21.Agrawal A, Parrott NR, Riad HN, Augustine T. Azathioprine-induced pure red cell aplasia: Case report and review. Transplant Proc 2004; 36:2689-91.  Back to cited text no. 21
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22.Khosroshahi HT, Asghari A, Estakhr R, Baiaz B, Ardalan MR, Shoja MM. Effects of azathioprine and mycophenolate mofetil immuno-suppressive regimens on the erythropoietic system of renal transplant recipients. Transplant Proc 2006;38:2077-9.  Back to cited text no. 22
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23.Willerding-Mollmann S, Wilkens L, Schlegel-berger B, Kaiser U. Azathioprine associated myelodysplastic syndrome with cytogenetic aberrations. Dtsch Med Wochenschr 2004;129: 1246-8.  Back to cited text no. 23
    
24.Naito M, Kawashima A, Akiba T, Takanashi M, Nihei H. Effects of an angiotensin II receptor antagonist and angiotensin-converting enzyme inhibitors on burst forming units-erythroid in chronic hemodialysis patients. Am J Nephrol 2003;23:287-93.  Back to cited text no. 24
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25.Le Meur Y, Lorgeot V, Comte L, et al. Plasma levels and metabolism of AcSDKP in patients with chronic renal failure: Relationship with erythropoietin requirements. Am J Kidney Dis 2001;38:510-7.  Back to cited text no. 25
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26.Molnar MZ, Czira ME, Rudas A, et al. Association between the malnutrition inflammation score and post-transplant anaemia. Nephrol Dial Transplant 2011;26:2000-6.  Back to cited text no. 26
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Correspondence Address:
Dawlat Sany
Assistant Professor, Division of Nephrology, Ain-Shams University, Cairo
Egypt
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