Prevalence, Etiologies, and Long-Term Impact of Early and Late Post-Transplant Anemia in Pediatric Kidney Transplant Recipients.

BACKGROUND

Anemia is a frequent complication in pediatric kidney transplant recipients and may adversely affect graft functions and long-term outcomes. However, data on post-transplant anemia (PTA) in children remain limited. The aim of this study was to investigate the prevalence and causative factors of PTA and the long-term effects of anemia on kidney functions in pediatric patients.

METHODS

This retrospective study included 68 pediatric kidney transplant recipients followed for at least 6 months at a tertiary referral center. Demographic, clinical, and laboratory data were collected from medical records. PTA was classified as early or late.

RESULTS

Early PTA was observed in 57.4% of the patients, primarily due to iron deficiency, and 28.2% of these cases became chronic. Older age at transplantation, pre-transplant presence of iron deficiency, and lower transferrin saturation levels were significantly associated with early PTA. At the 6th month, patients with early PTA had lower hemoglobin, lower estimated glomerular filtration rate (eGFR), and higher creatinine levels. Late PTA developed in 52.9% of the patients and was mostly due to iron deficiency, chronic kidney dysfunction, and rejection. At the final visit, patients with anemia had significantly lower eGFR, higher creatinine, and more frequent proteinuria and hyperparathyroidism. Left ventricular hypertrophy regressed markedly after transplantation and was not associated with anemia at follow-up.

CONCLUSIONS

Anemia was frequently encountered after pediatric kidney transplantation. Both early and late PTA were strongly linked to iron deficiency. Pre-transplant iron status emerged as a key modifiable risk factor. Anemia was associated with graft dysfunction, proteinuria, hyperparathyroidism, and rejection. In particular, patients with persistent anemia should undergo a comprehensive evaluation for potential etiological factors and be closely monitored with respect to graft functions.