Renal Transplantation

Abstract

The eventual commonplace use of recombinant human erythropoietin (r-HuEPo) for the treatment of the anemia associated with chronic renal failure will have definite consequences in the dialysis supported patient. The effect of this nonanemic state on renal transplantation, both in the early posttransplant period as well as the waiting period, was examined in this study. Thirteen of 16 patients who were treated with the hormone and subsequently underwent cadaveric renal transplantation (Tx) were compared to control transplant patients from a typical chronic renal patient population. There seemed to be no difference in the length of hospital stay, need for dialysis support post-Tx, or severity of acute post-Tx renal failure as measured by the days of dialysis support given. Furthermore, there seemed to be no evidence of marrow unresponsiveness to endogenous erythropoietin produced by the functioning allograft, so that after an initial fall in hemoglobin and hematocrit, these parameters returned to normal levels at three to six months. HLA antibody production was also tracked over the course of chronic r-HuEPo therapy, and the response followed one of three patterns: (a) initially very high (100%) or very low (< 15%) and showed no change; (b) moderate to high reactivity fell to lower levels with time; or (c) some stimulation noted without recent blood transfusions. Thus, patients entering end-stage renal failure without having been exposed to transfusions can be maintained in a low antibody state and perhaps increase the cadaveric kidneys available to them. Therefore, r-HuEPo therapy in patients who will subsequently undergo transplantation seems to have no deleterious effect on patient morbidity, or transplant outcome. There may be a long-term beneficial effect in reducing the number of highly sensitized patients awaiting transplant.