A Prospective Protocol-Based Trial of Darbepoetin Alfa Therapy to Correct the Early Anemia Following Renal Transplantation

Anemia is a common complication accompanying renal transplantation. The evaluation and therapy for posttransplant anemia (PTA) are not standardized and remain controversial. This was a prospective, protocol-driven attempt at early PTA evaluation and management by transplant nurse coordinators. Between 1 and 2 months posttransplantation, 75 consecutive recipients were evaluated for the presence and causes of anemia. Anemic patients were given standard doses of darbepoetin alfa (DA) for 3 months. Response to therapy and patient outcomes were evaluated over 15 months. Twenty-five (33%) of all patients were anemic, including 32% who were erythropoietin (EPO)-deficient and 68% with relative EPO resistance. No patient with early PTA showed an elevated EPO level or increased reticulocytes. Predisposing factors for early PTA included increased numbers of perioperative transfusions, deceased kidney donor, decrease reticulocyte count, and renal insufficiency. DA therapy corrected anemia in 20% of patients at 1 month and in 60% at 3 months. Patients unresponsive to standard DA doses were observed to display reduced renal function and new onset iron deficiency. Patients with prolonged PTA may represent a high-risk population requiring more intensive medical supervision. Nurses were able to efficiently direct DA therapy with only 1.7% protocol violations.