[Chronic anemia in heart transplant patients: prevalence, predisposing factors and prognostic significance]. / Anemia crónica en el trasplante cardiaco. Prevalencia, factores predisponentes y significado pronóstico.

INTRODUCTION AND OBJECTIVES: Data on chronic anemia following heart transplantation (HT) are scarce and contradictory. Our aims were to determine the prevalence of chronic anemia after HT, to identify predisposing factors for the condition at 12 months, and to evaluate its influence on medium-term and long-term survival. METHODS: Retrospective analysis of patients who underwent HT between 1991 and 2005 (n=457). Chronic anemia was defined as a hemoglobin level <12 g/dL. RESULTS: The prevalence of post-HT chronic anemia was 75.5% at 1 month, 31% at 12 months, and 26.2% at 120 months. The condition was significantly more prevalent among women than men. Predisposing factors for chronic anemia 1 year post-HT were mild-to-moderate chronic renal failure (i.e., creatinine level >1.5 mg/dL; odds ratio [OR]=2.8; 95% confidence interval [CI], 1.5-5.0), female sex (OR=6.4; 95% CI, 3.1-13.2), and immunosuppression with mycophenolate mofetil compared with azathioprine (OR=2.6;, 95% CI, 1.4-4.8). The prevalence of chronic anemia 12 months after HT was independent of the donor's sex, the recipient's age, the etiology of the recipient's heart failure, diabetes mellitus, mild-to-moderate graft rejection, cytomegalovirus infection, and angiotensin-converting enzyme inhibitor treatment. The presence of chronic anemia 12 months after HT did not influence either long-term survival (mean, 11.5 years with chronic anemia vs. 13.0 years without) or actuarial survival. CONCLUSIONS: Post-HT chronic anemia is common, but improves with time and treatment. Predisposing factors for the condition 1 year post-HT include chronic renal failure, female sex, and immunosuppression with mycophenolate mofetil. The presence of chronic anemia does not appear to influence long-term survival.

Anemia crónica en el trasplante cardiaco. Prevalencia, factores predisponentes y significado pronóstico / Chronic anemia in heart transplant patients: prevalence, predisposing factors and prognostic significance

Introducción y objetivos. La información disponible sobre anemia crónica (AC) en pacientes con trasplante cardiaco (TC) es escasa y discordante. Nuestro objetivo fue estudiar la prevalencia de AC en pacientes post-TC, factores predisponentes de AC a 12 meses y su significado pronóstico a medio y largo plazo. Métodos. Análisis retrospectivo de pacientes con TC entre 1991 y 2005 (n = 457). AC fue definida como hemoglobina < 12 g/dl. Resultados. La prevalencia de AC post-TC fue del 75,5% a 1 mes, el 31% a los 12 meses y el 26,2% a los 120 meses, significativamente más prevalente en mujeres que en varones. Factores predisponentes de AC a 12 meses: insuficiencia renal crónica (IRC) leve-moderada (creatinina > 1,5 mg/dl) (odds ratio [OR] = 2,8; intervalo de confianza [IC] del 95%, 1,5-5); sexo femenino (OR = 6,4; IC del 95%, 3,1-13,2), e inmunosupresión con micofenolato mofetilo (MMF) respecto a azatioprina (OR = 2,6; IC del 95%, 1,4-4,8). La prevalencia de AC 1 año tras el TC no se relacionó con el sexo del donante, la edad del receptor, la cardiopatía del receptor, la diabetes mellitus, el rechazo leve o moderado del injerto (≥ 3A), infección por citomegalovirus o tratamiento con inhibidores de la enzima de conversión de angiotensina. Tener AC a 1 año del TC no supuso diferencias en la supervivencia a largo plazo (tiempo de vida medio con AC, 11,5 años y sin AC, 13 años) ni en la supervivencia actuarial. Conclusiones. La AC post-TC es un problema frecuente que mejora con el tiempo y el tratamiento. La IRC, el sexo femenino y la inmunosupresión con MMF predisponen a AC a los 12 meses del TC. Tener AC no parece influir en la supervivencia a largo plazo (AU)

Introduction and objectives. Data on chronic anemia following heart transplantation (HT) are scarce and contradictory. Our aims were to determine the prevalence of chronic anemia after HT, to identify predisposing factors for the condition at 12 months, and to evaluate its influence on medium-term and long-term survival. Methods. Retrospective analysis of patients who underwent HT between 1991 and 2005 (n=457). Chronic anemia was defined as a hemoglobin level 1.5 mg/dL; odds ratio [OR]=2.8; 95% confidence interval [CI], 1.5­5.0), female sex (OR=6.4; 95% CI, 3.1­13.2), and immunosuppression with mycophenolate mofetil compared with azathioprine (OR=2.6;, 95% CI, 1.4­4.8). The prevalence of chronic anemia 12 months after HT was independent of the donor's sex, the recipient's age, the etiology of the recipient's heart failure, diabetes mellitus, mild-to-moderate graft rejection, cytomegalovirus infection, and angiotensin-converting enzyme inhibitor treatment. The presence of chronic anemia 12 months after HT did not influence either long-term survival (mean, 11.5 years with chronic anemia vs. 13.0 years without) or actuarial survival. Conclusions. Post-HT chronic anemia is common, but improves with time and treatment. Predisposing factors for the condition 1 year post-HT include chronic renal failure, female sex, and immunosuppression with mycophenolate mofetil. The presence of chronic anemia does not appear to influence long-term survival (AU)