PF430 EARLY POST‐TRANSPLANTATION ANEMIA IS ASSOCIATED WITH MORTALITY OR GRAFT FAILURE IN LIVER TRANSPLANTED ADULTS
Authors: Berger T. , Reisler I. , Shochat T. , Raanani P. , Mor E. , Gafter‐Gvili A. , Shlomai A. 
Published: June 2019

Background:

Post liver transplantation anemia (PLTA) in adults is a very common finding, but its characteristics and long‐term effect on major patients’ outcomes is still to be elucidated.

Aims:

To evaluate PLTA incidence, characteristics and predictors at 6 months (early PLTA) and 2 years (late PLTA) post liver transplantation. In addition, PLTA impact on various long‐term outcomes, including mortality, graft failure or mortality, malignancy and cardiovascular outcomes was assessed.

Methods:

This is a single center retrospective cohort study using prospectively collected data from a transplantation department registry. Liver transplantations of adult patients between the years 2007–2015 were identified and patients’ medical records evaluated. We assessed PLTA incidence, characteristics and predictors at different time points and evaluated whether PLTA is associated with 4 outcomes: (1) mortality, (2) the composite of mortality or graft failure, (3) major adverse cardiovascular events and (4) malignancy during a follow up of 3 years (available for all patients), as well as during the maximal individual follow‐up for each patient. Characteristics of patients who developed PLTA were compared in a univariate and multivariate analyses in order to find predictors for PLTA. Kaplan‐Meier survival analysis, using the log‐rank test, was used to compare time‐to‐event outcomes. Effect of different variables including PLTA on long term outcomes were evaluated through a univariate and multivariate analysis. Logistic regression was used to calculate univariate and multivariate odds ratios.

Results:

150 liver transplantations were included in the analysis. There was a 79% prevalence of anemia pre‐transplantation, whereas early and late PLTA were evident in 58% and 40% of patients, respectively. Pre‐transplantation anemia was associated with early PLTA and early PLTA was predictive of late PLTA. PLTA was normocytic, with increased RDW and increased in percentages of hypochromic RBCs. Chronic kidney disease was present in a quarter of patients with anemia. At a follow‐up of 3 years, patients with early PLTA or anemia at 1‐year post transplantation had a higher mortality rate compared with patients with normal hemoglobin level (12.79% vs. 3.17%, P = 0.0442 and 12.86% vs. 2.9%, P = 0.0552, respectively). In a multivariable analysis, existence of early PLTA (odds ratio [OR] 3.838, 95% CI 1.114–13.226) remained significantly associated with mortality or graft failure at 3 years of follow‐up. At a longer follow‐up (mean 5.5 ± 2.5 years) patients with anemia 1 year post transplantation had a higher mortality rate (p = 0.0323) and a higher rate of mortality or graft failure (p = 0.0249, Figure 1) according to survival analysis. Late PLTA was not significantly associated with worse long‐term outcomes.

Summary/Conclusion:

Early and late PLTA are prevalent among liver transplanted patients. Early PLTA is associated with long‐term mortality or graft failure.

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