Treatment With Darbepoetin During the First Year After Renal Transplantation: The Starting Point

• The introduction of DA was directly related to DGF and presence of albuminuria.
• The delayed introduction of DA meant less total dose than in early treatment, without a shorter time of treatment and with a parallel evolution in hemoglobin and renal function.
• It was difficult to describe the dose change pattern of DA treatment, considering that there was some variability of criteria because of the lack of guidelines in this subject.

IntroductionMultiple factors are associated with post-transplantation anemia, and renal function is the main factor. The aims of this study were to compare the evolution of hemoglobin in the first year post-transplantation according to darbepoetin (DA) treatment, and factors related to it, to evaluate the difference between earlier versus delayed treatment, and to describe the dose change pattern.Patients and MethodsWe describe a retrospective study of cohorts in 462 transplant recipients (2004–2011). The variables reported were from donor, transplantation recipient, and DA treatment.ResultsIn this study, 67.5% of patients were treated with DA, 32.5% were not. The comparison of hemoglobin in both groups during the first year showed a similar evolution with significant differences between consecutive measures until the second trimester. The hemoglobin of the treated group was significantly lower. The evolution of renal function was not different. Multivariate analysis related DA treatment to delayed graft function (DGF) and albuminuria in the first year. Patients with early versus delayed DA introduction did not show a difference regarding length of treatment, but the total dose in the delayed introduction was lower. The evolution of creatinine and hemoglobin was similar in both groups.ConclusionThe introduction of DA was related to DGF and albuminuria. The delayed introduction of DA meant the following: less total dose than earlier introduction, no difference in length of treatment, and a similar evolution in hemoglobin and renal function in both groups. The lack of guidelines about DA treatment in renal transplantation makes it difficult to establish a pattern of dose adjustment.