Increasing Incidence of Post‐Kidney Transplant Anemia in Children

Anemia status at 1‐year post‐kidney transplant was documented retrospectively in 231 pediatric recipients (mean age: 12.6 ± 5.0, range: 1.9–20.7 years) at Cincinnati Children's Hospital Medical Center between 1978 and 2003. Anemia was present in 59 (25.5%) patients. The prevalence of anemia has increased in the more recent eras (1978–1985: 7.8%, 1986–1997: 29%; 1998–2003: 32%, p < 0.01). Logistic regression analysis determined that the use of calcineurin inhibitors or impaired allograft function predicted anemia at 1‐year post‐transplant. Kaplan–Meier analysis showed that children with anemia at 1‐year post‐transplant had a significantly worse overall allograft survival than children without anemia (p = 0.02). However, when data were analyzed using a Cox proportional hazards model, only lower allograft function at 1‐year post‐transplant, black race and older era, but not anemia, independently predicted worse graft survival in children. This study suggests that the recent increase in the incidence of anemia post‐kidney transplant is related to modern immunosuppressive therapy and that post‐transplant anemia is more likely a marker of allograft dysfunction in children rather than its cause.