Post-transplant renal anemia: a call to action from a national study in routine clinical practice.

Background: Post-transplant anemia is a prevalent yet often overlooked condition that poses significant risks. Current guidelines consider the same treatment recommendations and goals for these patients as for chronic kidney disease patients not on dialysis. Previous reports demonstrated a lack of awareness and suboptimal management, indicating a pressing need for improvement. We therefore wanted to update the information on post-transplant anemia. We aimed to describe the present state of anemia management, goals and adherence to guidelines within a representative sample of the kidney transplant (KTx) population. Methods: We designed a retrospective nationwide multicenter study including outpatients from eight KTx hospitals. Nephrologists gathered data from electronic medical records encompassing demographics, comorbidities, KTx characteristics and immunosuppressive therapy, and information pertaining to anemia management (laboratory values, previously prescribed treatments and subsequent adjustments). The European statement on the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines was the reference for definitions, drug prescriptions and targets. Anemia occurring within the initial 6 months post-transplantation was classified as early onset. Results: We included 297 patients with post-transplant anemia aged 62.8 years (standard deviation 13.6), 60% of whom were male. They had received a graft from cardiac death or brain death donors (61.6% and 31.1%, respectively) a median of 2.5 years (0.5-8.7) before. Among them 77% ( Conclusion: We found that hemoglobin targets are individualized upwards in post-transplant anemia. In this setting, iron therapy continues to be underutilized, especially intravenous, and iron deficiency and prior events (blood transfusion or hospital admission) explain most of the hyporesponsiveness to ESA. This highlights missed opportunities for precise prescription targeting and adherence to established guidelines, suggesting a need for improved management strategies in post-transplant anemia patients.