Clinical and Anemia-Related Predictors of Short-Term Mortality in Renal Transplantation Recipients After Graft Rejection: A Retrospective Study.

Introduction: Renal transplantation is the treatment of choice for end-stage chronic kidney disease (CKD). Rejection is a relatively common complication and mortality is increased compared to the general population. There are several established predictors of mortality in patients with renal transplantation. We aimed to investigate whether these factors are also applicable after graft rejection and whether anemia and related factors have an impact on short-term mortality after graft rejection.

Methodology: We conducted a retrospective chart study in a high-volume tertiary care renal transplantation referral center. We obtained clinical, demographic, and mortality data, as well as anemia- and transplantation-related variables, via electronic medical records. We analyzed short-term (6 months) mortality and hematological characteristics based on baseline variables and mortality predictors. Two 3-variable models were constructed using multivariate logistic regression (MLR) to identify factors associated with short-term mortality.

Results: The analysis included 67 patients who had received renal transplantation, experienced graft rejection and mortality. Months to graft rejection after transplantation were 24 (117), and months to death after rejection were 10 (77). Months to death after rejection showed positive correlation with months to graft rejection after transplantation and lowest hemoglobin (Hb_min), and negative correlation with age at transplantation and ferritin levels. MLR demonstrated in 2 different models that either erythropoietin use, months to graft rejection after transplantation, and Hb_min, or erythropoietin use, months to graft rejection after transplantation, and Log_Ferritin are independently associated with short-term mortality.

Discussion: Anemia and high ferritin levels-markers of inflammation-are associated with increased short-term mortality, and erythropoietin use is associated with improved survival among patients with renal graft rejection, similar to patients with non-dialysis or dialysis CKD, as well as renal transplantation patients.