Role of erythropoietin in anemia after heart transplantation

Background Anemia after heart transplantation is common; however, there are scant data on etiology and treatment. This study evaluates type of anemia and the effects of erythropoietin therapy. Methods In 37 anemic heart transplant recipients (31 male/59.1 ± 10.3 years/hemoglobin < 12.0g/dl), complete anemia work-up was performed including erythropoietin determination. For three months, 12 anemic patients with renal failure (9 male/64.1 ± 13.6 years) were treated with 1–3 × 4000 IU of epoietin beta/week; treatment endpoints were hemoglobin levels and quality of life as determined by questionnaire. Results In 31 patients no other cause of anemia than renal insufficiency (mean creatinine 1.9 ± 0.9 mg/dl, mean calculated GFR 50.8 ± 21.5 ml/min, no hemodialysis) was found; in 93.5% of these patients with renal insufficiency, measured erythropoietin levels were markedly lower than predicted [Beguin Y, Clemons GK, Pootrakul P, Fillet G. Quantitative assessment of erythropoiesis and functional classification of anemia based on measurements of serum transferrin receptor and erythropoietin. Blood 1993; 81(4):1067-1076.]. There was an inverse correlation of hemoglobin levels with serum creatinine/creatinine clearance and a strong trend for inverse correlation of erythropoietin levels. All 12 patients treated with erythropoietin showed a significant increase in hemoglobin levels after three months returning to pre-treatment values within 3 months of cessation of therapy (before study 10.8 ± 1.1 g/dl, end of study 14.1 ± 1.7 g/dl, three months after end of study 11.6 ± 2.1 g/dl; p < 0.005). Quality of life was significantly improved in eight patients (75%). Conclusions Anemia after heart transplantation is associated with moderate renal failure and low erythropoietin levels in most patients. Erythropoietin therapy resulted in increased hemoglobin levels in all and improved quality of life in 75% of patients. Erythropoietin may be a superior marker of functional renal impairment after heart transplantation; its therapeutic substitution allows effective anemia management and improves quality of life.