Ferric carboxymaltose use in pediatric kidney transplant recipients with iron deficiency

BackgroundAnemia is a common complication in pediatric kidney transplant recipients (KTR). Post-transplantation anemia (PTA) is multifactorial with iron deficiency being a frequent cause. Oral iron supplementation is often ineffective. Ferric carboxymaltose (FCM) is an intravenous iron formulation but its safety and efficacy in pediatric KTR has not yet been established.MethodsThis is a single-center, retrospective cohort study evaluating all consecutive KT patients diagnosed with iron deficiency (ID) and/or iron deficiency anemia (IDA), defined by KDIGO guidelines, who received FCM between December 2016 and November 2022.ResultsFifteen patients had ID and ten of them also showed IDA. Hemoglobin, transferrin saturation percentage (TSat) and ferritin levels were assessed at baseline and at one, three, six and twelve months, after a median (IQR) post-transplant follow-up of 41.8 months (11.3-72.6). At each follow-up time point, the median increase of Hb levels ranged from 1.2 to 1.4 g/dl. Ferritin levels significantly increased up to six months post-treatment, while TSat improved at 30 days. Phosphate levels did not show any decrease throughout follow-up and no adverse reactions were observed in our study population.ConclusionsOur experience suggests that FCM is an effective and well-tolerated treatment for pediatric kidney transplant recipients with ID and/or IDA and highlights the need for larger, well-powered trials to definitively test FCM in this population.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information