Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9

Chronic anemia in long-term follow-up after cardiac transplantation
E. Alyaydin1, C. Pogoda2, J. Sindermann3, I. Tuleta4
1Klinik für Kardiologie I: Koronare Herzkrankheit, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Münster; 2Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Münster; 3Interdisziplinäre Sektion Herzinsuffizienz, Universitätsklinikum Münster, Münster; 4Albert Einstein College of Medicine, New York, US;

Background: Anemia is a common condition in solid organ transplantation. It is often secondary to chronic immunosuppression, renal insufficiency and chronic inflammation. However, to the best of our knowledge, the reports on adult heart transplantation (HTx) are limited to small cohorts and short-term follow-up.

Aim: To assess the etiology, prevalence and prognostic relevance of anemia in a very long-term follow-up after heart transplantation.

Methods: We performed a retrospective analysis of the data collected at last follow-up visit in our outpatient clinic for HTx. These included demographics, clinical examination results and complete blood count (CBC).

Results: The study population consisted of 185 patients with a mean follow-up of 15.0 ± 6.9 years and a mean age at the time of HTx of 44.8 ± 15.5 years. Main CBC parameters are demonstrated in Table 1. One-fifth of the patients were female (Table 2). More than half of the female and almost two-third of the male patients had anemia according to the definition of WHO (haemoglobin value (Hb) < 13.0 g/dL in male and < 12.0 g/dL in female). Patients with anemia were older at the time of HTx (p = 0.001); had as expected more impaired renal function, expressed as glomerular filtration rate (GFR, p < 0.001) and more often end-stage renal disease (ESRD, p = 0.004); were frequently on cyclosporine A (CSA)-based immunosuppressive regime (p = 0.003), although there was no relevant difference in the CSA blood concentration (p = 0.34). Patients with anemia presented with worse functional class according to the New York Heart Association classification (NYHA), (p = 0.008). When adjusted for renal function and age, we observed no significant mortality risk associated with anemia in a multivariate logistic regression analysis (p = 0.46, HR 0.78, 95% CI 0.41 – 1.50).

Conclusions: Anemia is a highly prevalent condition in cardiac transplantation, mainly in older transplant recipients and in patients with impaired renal function. It is associated with relevant functional impairment, but we observed no prognostic relevance. This can be due to the retrospective character of our analysis and the effect of intermittent substitution.

Table 1. 

CBC parameter

Mean value ± SD

Haemoglobin, g/dL

12.4 ± 1.8

Haematocrit, %

38.1 ± 5.3

MCV, fl

88.2 ± 7.3

MCH, pg

28.9 ± 4.5

MCHC, g/dL

32.4 ± 1.3

 
Table 2.

Patient characteristics

Anemic

Non-anemic

Female, n = 35 (18.9 %)

19 (54.3 %)

16 (45.7 %)

Male, n = 150 (81.1 %)

93 (62.0 %)

57 (38.0 %)

Age at HTx, years

47.9 ± 15.5

40.2 ± 14.3

GFR, ml/min/1.73 m2

35.9 ± 24.8

55.3 ± 23.0

ESRD, n (%)

29 (25.9 %)

6 (8.2 %)

CSA, n (%)

70 (62.5 %)

29 (39.7 %)

CSA blood concentration, ng/mL

138.7 ± 54.9

127.8 ± 42.9

 

https://dgk.org/kongress_programme/ht2021/P82.htm