Erythropoietin response to post-liver transplantation anemia

Anemia frequently accompanies end-stage liver disease. Erythropoietin has r ecently been shown to be of benefit in a number of diseases complicated by anemia. We studied erythropoietin levels before and after orthotopic liver transplantation (OLT) and correlated these with the degree of anemia. Twent y-seven patients with end-stage cirrhosis who underwent OLT had preoperativ e and weekly postoperative serum erythropoietin levels determined by a high ly sensitive radioimmunoassay. The relation of erythropoietin level to the values for hematocrit, serum creatinine, and cyclosporine and other biochem ical test results was evaluated. Before transplantation, 23 patients were a nemic; erythropoietin levels were appropriately elevated (72.7 +/- 37 mU/mL ; normal, 10 to 15 mU/mL) for the degree of anemia (hematocrit, 33.1% +/- 1 %) in 16 patients (70%). A blunted erythropoietin response to anemia was fo und in 7 of the anemic patients with cirrhosis (30%). After OLT, the hemato crit decreased to 29.5% +/- 0.6% at 4 weeks, with a reciprocal increase in serum erythropoietin levels to 36 +/- 5 mU/mL. Erythropoietin response appe ared appropriate to the degree of anemia in 82% of the liver transplant rec ipients and blunted in 18%, We conclude that the ability to secrete erythro poietin in response to anemia is defective in many patients with end-stage liver disease, and a normal response may be restored after OLT. The results suggest that exogenous erythropoietin administration may be beneficial in anemic patients with cirrhosis and liver transplant recipients who have ina ppropriately low serum erythropoietin levels.