A Systematic Review and Meta-Analysis of Posttransplant Anemia With Overall Mortality and Cardiovascular Outcomes Among Kidney Transplant Recipients

Introduction: Posttransplant anemia is a common finding after kidney transplantation. A previous meta-analysis reported an association between anemia and graft loss. However, data on cardiovascular outcomes have not yet been reported. Objective: We conducted an updated meta-analysis to examine the association between posttransplant anemia and outcomes after transplantation including cardiovascular mortality in adult kidney transplant recipients. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to November 2021. Data from each study were combined using the random-effects model. Generic inverse variance method of DerSimonian and Laird was employed to calculate the risk ratios (RRs) and 95% confidence intervals (CIs). Results: Seventeen studies from August 2006 to April 2019 were included (16 463 kidney transplantation recipients). Posttransplant anemia was associated with overall mortality (pooled RR = 1.72 [1.39, 2.13], I-2 = 56%), graft loss (pooled RR = 2.28 [1.77, 2.93], I-2 = 94%), cardiovascular death (pooled RR = 2.06 [1.35, 3.16], I-2 = 0%), and cardiovascular events (pooled RR = 1.33 [1.10, 1.61], I-2 = 0%). Early anemia (<= 6 months), compared with late anemia (> 6 months), has higher risk of overall mortality and graft loss with a pooled RR of 2.63 (95% CI 1.79-3.86; I-2 = 0%) and 2.96 (95% CI 2.29-3.82; I-2 = 0%), respectively. Discussion: In addition to increased risk of graft loss, our updated meta-analysis demonstrated that posttransplant anemia was significantly associated with poor outcomes after kidney transplantation including overall mortality, graft loss, cardiovascular death, and cardiovascular events. Future studies are required to assess the effects of treatment strategies for posttransplant anemia on posttransplant outcomes including cardiovascular mortality.