CF Patients at Greater Anemia Risk After Lung Transplant, Study Finds

Post-transplant anemia was four times higher for CF than other lung diseases

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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Anemia is common among lung transplant recipients, and people with cystic fibrosis (CF) are at more than four times greater risk of developing anemia post-transplant compared to those with other lung diseases.

That’s according to the study “Post-Transplantation Anemia and Risk of Death Following Lung Transplantation,” published in the journal Transplantation Proceedings.

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Post-transplant anemia is a common complication after organ transplants

Post-transplant anemia, or PTA, is a common complication that can develop after solid organ transplants. A variety of different transplant-related effects, including blood loss during surgery, inflammation, and nutritional deficiencies, can ultimately give rise to anemia — when the body does not have enough hemoglobin to transport oxygen to all its tissues.

Most research on PTA has focused on kidney transplant recipients. Lung transplant (LTx) is a well-established treatment for severe respiratory diseases, but the impact of post-transplant anemia in this condition has not been thoroughly studied.

To learn more, a team of researchers in Denmark conducted a retrospective analysis of people who underwent lung transplant at Copenhagen University Hospital between 2010 and 2019.

“The primary aim of this study was to determine the prevalence of PTA during the first 3 years post-LTx. Furthermore, we wished to examine the severity of anemia and establish possible risk factors for development of PTA,” the scientists wrote.

“To our knowledge, no other recent studies have examined the incidence, severity, and clinical consequences of PTA in LTx recipients,” they added.

A total of 278 lung transplant recipients, including 48 individuals diagnosed with CF, were included in the analysis. The most common reason for the transplant, in nearly half of the patients, was emphysema. Prior to their transplant, 57 (21%) patients had (mostly mild) anemia, including 27 people with CF.

“CF only constituted 17% of the total population but accounted for 47% of the anemic patients at baseline,” the researchers wrote.

One month after their transplants, nearly all (98.2%) of the patients were anemic. At one year after their transplants, 74.8% of patients had anemia, and 52% had anemia at three years post-transplant.

“We found a high prevalence of PTA among LTx recipients during their first three years post-LTx,” the researchers wrote. “Anemia was observed in most of the cohort at all time points post-LTx.”

The team noted that anemia was generally moderate in severity during the first few months after transplant, but by three months after the surgery, most patients had mild anemia.

The investigators conducted a battery of statistical analyses to look for demographic and clinical factors that were associated with an increased risk of post-transplant anemia after one year or three years. Results showed that being male was associated with more than double the risk of post-transplant anemia.

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Analyses also showed that the risk of post-transplant anemia was increased more than fourfold in people with CF compared to those with pulmonary fibrosis or emphysema.

“CF was significantly associated with higher odds of anemia throughout the study period,” the researchers wrote, though they noted that “whether anemia also has an impact on respiratory function and excess mortality in lung-transplanted CF patients is still unknown.”

The three-year survival rate among all the lung transplant recipients was 76%. An initial analysis indicated an increased risk of mortality in patients with moderate or severe anemia, compared to those with mild or no anemia, but results did not consistently show statistical significance. The study may have been too small to detect a statistically significant association, the researchers noted.

“Excess mortality in recipients with moderate or severe anemia compared to recipients with mild or no anemia was borderline significant at one year post−lung transplantation,” the scientists concluded.

“Whether a more aggressive approach to treatment of PTA could reduce mortality and improve the quality of life in lung transplant recipients is still unknown,” they added. “Further investigation on post-LTx anemia, the underlying mechanisms, and its clinical impact is needed.”

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