RECOMBINANT-HUMAN-ERYTHROPOIETIN TREATMENT OF ANEMIA IN RENAL-TRANSPLANT PATIENTS

The rHuEpo effect on anemia in eight renal transplant patients (group A) with severe anemia (Hb 6.0-7.5 g/dL) and chronic graft failure (CGF ) (sCr 281-794 mu mol/L) was compared to the rHuEpo effect on anemia i n predialysis (20 patients--group B) and hemodialysis patients (17 pat ients--group C) in order to examine the rHuEpo effect on anemia and gr aft failure progression, and to find out whether the response to thera py in these three patient groups differed. Although renal function imp airment was similar in patients from group A and B, anemia was more se vere in patients from group A. Serum immunoreactive erythropoietin lev els were within normal limits for nonanemic persons, that is, inadequa te for the level of anemia in all patients before therapy. Maintenance immunosuppression given after renal transplantation consisted of cycl osporine, azathioprine, and prednisone in standard doses. The starting rHuEpo dose of 150 U/kg/wk increased by 25 U/kg if the target Hb of 1 0.0 g/dL was not achieved at the end of a 4-week period. When target H b was achieved, the rHuEpo dose was regularly adjusted to maintain Hb of 10.0 g/dL. Most patients from group A and group C were polytransfus ed before rHuEpo therapy and consequently with iron overload so that o nly some patients from these groups and all predialysis patients neede d iron supplementation given orally. Anemia improved in all patients w ith 2 To 10 weeks of treatment. Mean rHuEpo doses for the first 2 mont hs were similar in three studied groups, but the patients with the low est initial hemoglobin values responded better to rHuEpo therapy. The rare of Hb increase during the initial phase of therapy was significan tly higher in patients from group A and B comparing to patients from g roup C, indicating the importance of residual renal function for rHuEp o effect on anemia. Progression of CGF expressed by the slope of 1/sCr vs. time did not change in either patients from group A or in predial ysis patients. It could be concluded that rHuEpo therapy improved anem ia in transplant patients as in predialysis and hemodialysis patients. Anemia improvement by rHuEpo did not accelerate the progression of gr aft function.