ANEMIA IN LIVING DONOR RENAL TRANSPLANT RECIPIENTS: MODE OF RECOVERY - WHEN AND HOW?

 

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ANEMIA IN LIVING DONOR RENAL TRANSPLANT RECIPIENTS: MODE OF RECOVERY - WHEN AND HOW?

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Khin Phyu
Pyar
Khin Phyu Pyar khinphyupyar@gmail.com Defence Services Medical Acadamy Medicine Yangon Myanmar *
Win Min Tun dr.wmtun@gmail.com Defence Services Medical Acadamy Medicine Yangon Myanmar -
Soe Min Aung soemina510@gmail.com Defence Services Medical Acadamy Medicine Yangon Myanmar -
Zar Ni Htet Aung znha474@gmail.com No.1 Defence Services General Hospital Medicine Yangon Myanmar -
Soe Win Hlaing dr.soewinhlaing@gmail.com No.1 Defence Services General Hospital Medicine Yangon Myanmar -
San San Win drsswinpatho@gmail.com Defence Services Medical Acadamy Pathology Yangon Myanmar -
Pyae Sone Htun pyaesonehtun123@gmail.com Defence Services Medical Acadamy Preventive and Social Medicine Yangon Myanmar -
Nyan Lin Maung dr.nyanlinmg@gmail.com Defence Services Medical Acadamy Medicine Yangon Myanmar -
Kyaw Zay Ya kyawzayakzy@gmail.com Defence Services Medical Acadamy Medicine Yangon Myanmar -
Ye Min Thu yeminthu.ygn@gmail.com Defence Services Medical Acadamy Medicine Yangon Myanmar -
Aung Htoo Kyaw aunghtookyaw.ahk@gmail.com Defence Services Medical Acadamy Medicine Yangon Myanmar -
Soe Ko Ko Oo dr.soekkoo@gmail.com Defence Services Liver Hospital Medicine Yangon Myanmar -
Thurein Win dr.thureinwynn@gmail.com Defence Services Medical Acadamy Medicine Yangon Myanmar -
Wai Lynn Aung dr.wailynn@gmail.com Defence Services Medical Acadamy Medicine Yangon Myanmar -
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People with end stage renal disease have anemia mainly due to erythropoietin deficiency. Living donor renal transplantation corrects anemia by restoring endogenous erythropoietin production. Timing of recovery of anemia and its progress over time in living donor renal transplant recipients were not studied in Myanmar. This study found out improvement in anemia and its mode of recovery over six months in living donor renal transplant recipients.

A hospital-based longitudinal study was conducted at 1,000 bedded public hospital in Myanmar from December 2023 to July 2025. After getting informed consent, clinical examination, red cell indices (Hemoglobin, RBC count, Hematocrit HCT and RBC distribution width RDW) and serum creatinine were measured at ten time-points; pre-transplant period, Day 1, Day 7, Day 14, Month 1, Month 2, Month 3, Month 4, Month 5 and Month 6. 

A total of  57 living donor renal transplant recipients were included; all recipients had normochromic normocytic anemia prior to transplant. Mean pre-transplant hemoglobin (Hb) was 10.64 ± 1.2 g/dL. And it fell  to 8.83 ± 1.4 g/dL on Day 1. Then, it progressively increased to 12.59 ± 1.6 g/dL at Month 2, to 12.68 ± 1.5 g/dL at Month 3 and 13.39 ± 1.5 g/dL at Month 6. Both RBC count and HCT showed parallel recovery pattern. RDW peaked at 16.45% on Day 14 and stabilized at 13.74% by Month 6. At Month 6, anemia resolved in 93.0% (53/57). And, 7.0% (4/57) of them remained anemic; their mean hemoglobin was 10.1 g/dL. Two of them had SLE (systemic lupus erythematosus) and they had bone marrow involvement of SLE. The remaining two recipients had chronic rejection and their serum creatinine was 1.4 mg%. Hb improvements generally paralleled with creatinine declines.

Figure (1) Changes in hemoglobin from pre-transplant period to 6 months in living donor renal transplant recipients (n=57)

Figure (2) Changes in RBC count from pre-transplant period to 6 months in living donor renal transplant recipients (n=57)

Figure (3) Changes in hematocrit level from pre-transplant period to 6 months in living donor renal transplant recipients (n=57)

Figure (4) Changes in RDW from pre-transplant period to 6 months in living donor renal transplant recipients (n=57)


All recipients had anemia in pre-transplant period. In most recipients, hemoglobin increased significantly by Month 2 and it became normal by Month 6. A clinically relevant inverse trend was observed between Hb and creatinine though statistical correlations was weak.

Kewords