ABSTRACT
Introduction: Post-transplant anemia (PTA) is a common serious complication following kidney transplantation. It affects graft and patient survival. Anemia that presents within six months post-transplantation is defined as an early PTA. Late PTA is when anemia occurs more than six months following transplantation. Despite this, there are limited studies on the long-term impact of anemia on patient survival and graft function in kidney transplants. We conducted a retrospective study with long-term follow-up to investigate the effect of early and late PTA on patient and graft function within seven years and to estimate the prevalence of PTA at six months, two, four, and seven years postrenal transplantation along with the associated risk factors. Method: A retrospective chart review of 145 adult patients who had kidney transplants from January 1 to December 31, 2015, and were followed up until December 31, 2022. Anemia was defined according to the World Health Organization (WHO) criteria of hemoglobin<12 gm/dl in females and<13 mg/dl in males. Pretransplant, six months, two, four, and seven years postrenal transplantation medications and laboratory data were obtained. Patients were excluded if they were pediatrics or had missing data. Result: 180 patients were screened, and 145 patients met the inclusion criteria. The prevalence of early PTA was 8.3%. Trimethoprim-sulfamethoxazole was significantly associated with anemia within six months. The prevalence of anemia increased at two, four-, and seven-years post-transplant (24.8%, 24.8%, and 27.6%, respectively). Graft failure was significantly associated with late PTA at four and seven years (p-value < 0.001). P < 0.005, respectively). Death was reported for 3 patients, and it was significantly associated with late transplant anemia (p-value < 0.005), Cytomegalovirus was associated with anemia at 6 months and 2 years post-transplant and significantly associated with graft failure (p-value < 0.037). Conclusion: The results of this study indicate that post-transplant anemia is associated with graft failure and patient mortality. Therefore, managing anemia post-transplant should be addressed more carefully.
ABSTRACT
Solid organ transplant (SOT) recipients are at increased risk of COVID-19 infection because of their suppressed immunity. The available data show that COVID-19 vaccines are less effective in SOT recipients. We aimed to assess the cellular and humoral immunogenicity with an increasing the number of doses of COVID-19 vaccines in SOT recipients and to identify factors affecting vaccine response in this population. A systematic review and meta-analysis were conducted to identify ongoing and completed studies of humoral and cellular immunity following COVID-19 vaccines in SOT recipients. The search retrieved 278 results with 45 duplicates, and 43 records did not match the inclusion criteria. After title and abstract screening, we retained 189 records, and 135 records were excluded. The reasons for exclusion involved studies with immunocompromised patients (non-transplant recipients), dialysis patients, and individuals who had already recovered from SARS-CoV-2 infection. After full-text reading, 55 observational studies and randomized clinical trials (RCTs) were included. The proportion of responders appeared higher after the third, fourth, and fifth doses. The risk factors for non-response included older age and the use of mycophenolate mofetil, corticosteroids, and other immunosuppressants. This systematic review and meta-analysis demonstrates the immunogenicity following different doses of COVID-19 vaccines among SOT patients. Due to the low immunogenicity of vaccines, additional strategies to improve vaccine response may be necessary.
