Increasing hematocrit reduces early posttransplant cardiovascular risk in diabetic transplant recipients

Transplantation. 2003 Sep 15;76(5):816-20. doi: 10.1097/01.TP.0000084872.26360.C5.


Background: Cardiovascular disease remains epidemic in transplant recipients, despite aggressive treatment of cardiovascular risk factors. Thus, novel risk factors could play a role in the genesis of cardiovascular events in this population.

Methods: We evaluated the impact of early posttransplant anemia on cardiovascular events. We examined rolling average hematocrit values at 30-day intervals and determined the effect of increasing hematocrit on the risk for cardiovascular (CV) events in a single-center population of 404 type 1 diabetic end-stage renal disease patients who underwent either cadaveric kidney transplantation alone or simultaneous pancreas-kidney transplantation.

Results: Greater than 60% of the individuals in the study cohort had hematocrit less than or equal to 30% at least once during the first 30 days posttransplant. Forty-two individuals (10.4% of the study population) had at least one 30-day rolling hematocrit less than or equal to 30% and a CV event (myocardial infarction, CV death, angina, congestive heart failure) during the first 26 weeks of the posttransplant course. Increasing hematocrit (>30%) led to a reduction in the risk ratio (RR) for a CV event compared with hematocrit less than or equal to 30% (RR, 0.237; P=0.015). The association between anemia and CV events remained statistically significant in a multivariate analysis (RR, 0.65; P=0.022) that also included age and a history of pretransplant ischemic heart disease.

Conclusions: These data suggest that anemia is an important risk factor for early posttransplant CV events in a high-risk population. Prospective studies of anemia management therapy in this setting are warranted to determine whether this will reduce early posttransplant CV risk.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Anemia / diagnosis
  • Anemia / epidemiology*
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Diabetes Mellitus, Type 1 / surgery*
  • Female
  • Hematocrit
  • Humans
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation / statistics & numerical data*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Ischemia / epidemiology
  • Pancreas Transplantation / statistics & numerical data*
  • Peripheral Vascular Diseases / epidemiology
  • Retrospective Studies
  • Risk Factors