Effect of High-Dose Erythropoietin on Graft Function after Kidney Transplantation: A Randomized, Double-Blind Clinical Trial

• Published in: Clinical journal of the American Society of Nephrology Vol. 7; no. 9; pp. 1498 - 1506
• Main Authors: Sureshkumar, Kalathil K, Hussain, Sabiha M, Ko, Tina Y, Thai, Ngoc L, Marcus, Richard J
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01.09.2012
• Subjects: Acute-Phase Proteins - urine; Adult; Aged; Analysis of Variance; Biomarkers - blood; Biomarkers - urine; Blood Pressure - drug effects; Chi-Square Distribution; Creatinine - blood; Creatinine - urine; Delayed Graft Function - blood; Delayed Graft Function - epidemiology; Delayed Graft Function - prevention & control; Delayed Graft Function - urine; Double-Blind Method; Drug Administration Schedule; Epoetin Alfa; Erythropoietin - administration & dosage; Female; Hemoglobins - metabolism; Humans; Incidence; Injections, Intra-Arterial; Interleukin-18 - urine; Kidney Transplantation - adverse effects; Lipocalin-2; Lipocalins - urine; Male; Middle Aged; Original; Pennsylvania - epidemiology; Prospective Studies; Proto-Oncogene Proteins - urine; Recombinant Proteins - administration & dosage; Reperfusion Injury - blood; Reperfusion Injury - epidemiology; Reperfusion Injury - prevention & control; Reperfusion Injury - urine; Time Factors; Treatment Outcome; Young Adult
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.01360212

Delayed graft function (DGF) is associated with adverse long-term outcomes after deceased-donor kidney (DDK) transplantation. Ischemia-reperfusion injury plays a crucial role in the development of DGF. On the basis of promising animal data, this study evaluated any potential benefits of erythropoietin-alfa (EPO-α) given intra-arterially at the time of reperfusion of renal allograft on the degree of allograft function, as well as tubular cell injury measured by urinary biomarkers in the early post-transplant period. A prospective, randomized, double-blind, placebo-controlled clinical trial was conducted to evaluate the influence of EPO-α administered intraoperatively on the outcomes of DDK transplantations performed at the study center between March 2007 and July 2009. Seventy-two patients were randomly assigned to EPO-α (n=36) or placebo (n=36). The incidences of DGF, slow graft function, and immediate graft function did not significantly differ between the treatment and control groups (41.7% versus 47.2%, 25.0% versus 36.1%, and 33.3% versus 16.7%, respectively; P=0.24). The groups had similar levels of urinary biomarkers, including neutrophil gelatinase-associated lipocalin and IL-18 at multiple times points soon after transplantation; urinary output during the first 3 postoperative days; 1-month renal function; and BP readings, hemoglobin, and adverse effects during the first month. This study did not show any clinically demonstrable beneficial effects of high-dose EPO-α given intra-arterially during the early reperfusion phase in DDK transplant recipients in terms of reducing the incidence of DGF or improving short-term allograft function.