A systematic review and meta-analysis of factors contributing to post-kidney transplant anemia and the effect of erythropoietin-stimulating agents.
Chienwichai, K., et al.Systematic Reviews 2024; 13(1): 278.
Aims
The aim of this study was to determine the risk factors associated with post-kidney transplant anemia (PTA) and to examine the effect of erythropoietin-stimulating agents (ESAs) on outcomes following kidney transplantation.
Interventions
MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials databases were searched for relevant articles. Studies were selected for inclusion by two independent reviewers. The methodological quality of the included studies were assessed using the revised Cochrane risk of bias tool for randomised controlled trials, Newcastle–Ottawa scale (NOS) for cohort studies, and the adapted NOS for cross-sectional studies.
Participants
85 studies were included in the review.
Outcomes
The main outcomes of interest included risk factors predicting PTA, factors associated with PTA, and the effect of ESA on delayed graft function, rejection, graft loss, graft thrombosis, non-graft thrombosis, death, estimated glomerular filtration rate (eGFR), haemoglobin (Hb) levels.
Follow-up
N/A
CET Conclusions
This systematic review aimed to evaluate the risk factors for post-kidney transplant anaemia (PTA) and investigate the influence of erythropoietin-stimulating agents (ESAs) on post-kidney transplant outcomes. The study included a total of 85 studies with different study designs including randomised controlled trials, retrospective/prospective cohort studies and cross-sectional studies. Study screening and quality assessment were performed by two independent authors. Factors that contributed to PTA were categorised as risk factors (defined as cause-effect relationships) and associated factors (defined as those without definite cause-effect relationships). Older donor age, African-American race, human antigen leukocyte mismatches, and low pre-transplant hemoglobin levels were identified as the risk factors for PTA. The associated factors for PTA were found to be delayed graft function, poor allograft function, cytomegalovirus (CMV), high interleukine-6, immunosuppressive medications and renin-angiotensin system blockades. In addition, late therapy with ESA targeted at haemoglobin normalization was found to significantly reduce mortality. The criteria used by the authors to establish which factors suggested a “definite” and “without definite” cause-effect relationship (i.e. risk factor versus associated factor) has not been clearly described in the paper. Furthermore, the paper does not mention whether data were extracted in duplicate, which may have compromised the accuracy of the extracted data.
Trial registration
PROSPERO - CRD42024545330