Recombinant Human Erythropoietin for Kidney Transplantation: A Systematic Review and Meta-Analysis
Vol. 17 No. 3 (2020),
16 May 2020
AbstractPurpose: The protective effect of recombinant human erythropoietin (rHuEPO) on kidney transplantation has not been established. Therefore, we conducted a systematic review and meta-analysis to evaluate the potential influence of rHuEPO on transplanted kidneys.
Materials and methods: To identify relevant studies, we searched electronic databases (PubMed, Medline, EMBASE, Ovid, the Cochrane Library, and major nephrology journals) from inception until June 15, 2018. Two independent reviewers assessed study quality. The systematic review and meta-analysis were performed with fixed- or random-effects models according to heterogeneity, and results are expressed as risk ratios (RR) or weighted mean differences.
Results: Six randomized controlled trials with a total of 435 patients met the inclusion criteria. rHuEPO, compared with placebo, had no statistically significant effect on delayed graft function (RR = 0.89, 95% confidence interval [CI] , 0.73 to 1.07; P = 0.22) and slow graft function (RR = 0.93, 95% CI, 0.60 to 1.43; P = 0.73). The rHuEPO and control groups did not differ in thromboembolic events, mortality, acute rejection, and blood transfusion. A significant difference was found in long-term estimated glomerular filtration rate (RR = 3.65, 95% CI, -4.45 to 11.75; P = 0.003).
Conclusion: Our findings suggests that rHuEPO has a limited nephroprotective effect in patients undergoing kidney transplantation and does not increase the susceptibility to adverse events.
- recombinant human erythropoietin
- kidney transplantation
- allograft function
- delayed graft function
- systematic review and meta-analysis
How to Cite
Brines M, Cerami A. Discovering erythropoietin’s extrahematopoietic functions: biology and clinical promise. Kidney Int. 2006; 70: 246-50.
Lappin TR, Maxwell AP, Johnston PG. EPO’s alter ego: erythropoietin has multiple actions. Stem Cells. 2002; 20: 485-92.
Goldman SA, Nedergaard M. Erythropoietin strikes a new cord. Nat Med. 2002; 8:785-87.
Chateauvieux S, Grigorakaki C, Morceau F, Dicato M, Diederich M. Erythropoietin, erythropoiesis and beyond. Biochem Pharmacol. 2011;10: 1291-303.
Celik M, Gokmen N, Erbayraktar S, Akhisaroglu M, Konakc S, Ulukus C, et al. Erythropoietin prevents motor neuron apoptosis and neurologic disability in experimental spinal cord ischemic injury. Proc Natl Acad Sci USA. 2002; 99: 2258-63.
Toro L, Barrientos V, León P, Rojas M, Gonzalez M, González-Ibáñez A, et al. Erythropoietin induces bone marrow and plasma fibroblast growth factor 23 during acute kidney injury. Kidney Int. 2018;93:1131-41.
Parsa CJ, Matsumoto A, Kim J, Riel RU, Pascal LS, Walton GB, et al. A novel protective effect of erythropoietin in the infarcted heart. J Clin Invest. 2003; 112: 999-1007.
Reynolds BC, Tinckam KJ. Sensitization assessment before kidney transplantation.Transplant Rev (Orlando). 2017; 31:18-28.
Zomorrodi A, Mohammadipoor Anvari H, Kakaei F, Solymanzadeh F, Khanlari E, Bagheri A. Bolus Injection Versus Infusion of Furosemide in Kidney Transplantation: A Randomized Clinical Trial. Urol J. 2017; 4:3013-7.
Gill JS, Tonelli M, Mix CH, Pereira BJ. The change in allograft function among long-term kidney transplant recipients. J Am Soc Nephrol. 2003; 14:1636-42.
Yarlagadda SG, Coca SG, Formica RJ, Poggio ED, Parikh CR. Association between delayed graft function and allograft and patient survival: A systematic review and meta-analysis. Nephrol Dial Transplant. 2009; 24:1039-47.
Matas AJ, Smith JM, Skeans MA, Thompson B, Gustafson SK, Schnitzler MA, et al. OPTN/SRTR 2012 Annual Data Report: kidney. Am J Transplant. 2014; 14 1:11-44.
Panic N, Leoncini E, de Belvis G, Ricciardi W, Boccia S. Evaluation of the endorsement of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement on the quality of published systematic review and meta-analyses. PLoS One. 2013; 26: e83138.
Sureshkumar KK, Hussain SM,Tina Y, Thai NL, Marcus RJ. Effect of High-Dose Erythropoietin on Graft Function after Kidney Transplantation: A Randomized, Double-Blind Clinical Trial. Clin J Am Soc Nephrol. 2012; 7: 1498-506.
Aydin Z, Mallat M, Schaapherder A, van Zonneveld AJ, van Kooten C, Rabelink TJ, et al. Randomized Trial of Short-Course High-Dose Erythropoietin in Donation After Cardiac Death Kidney Transplant Recipients. Am J Transplant. 2012; 12: 1793-800.
Hafer C, Becker T, Kielstein JT, Bahlmann E, Schwarz A, Grinzoff N, et al. High-dose erythropoietin has no effect on short- or long-term graft function following deceased donor kidney transplantation. Kidney Int. 2012; 81:314-20.
Martinez F, Kamar N, Pallet N, Lang P, Durrbach A, Lebranchu Y, et al. High dose epoetin beta in the first weeks following renal transplantation and delayed graft function: results of the Neo-PDGF Study. Am J Transplant. 2010; 10: 1695-700.
Nafar M, Abdei BA, Ahmadpoor P, Ahmadpoor P, Pour-Reza-Gholi F, Samadian F, et al. Effect of erythropoietin on kidney allograft survival: early use after transplantation. Iran J Kidney Dis. 2012; 6: 44-8.
Coupes B, de Freitas DG, Roberts SA, Read I, Riad H, Brenchley PE, et al. rhErythropoietin-β as a tissue protective agent in kidney transplantation: a pilot randomized controlled trial. BMC Res Notes. 2015; 3:21.
Simforoosh N, Basiri A, Tabibi A, Javanmard B, Kashi AH, Soltani MH, et al. Living Unrelated Versus Related Kidney Transplantation: a 25-year Experience with 3716 Case. Urol J. 2016; 13:2546-51.
Bohlius J, Schmidlin K, Brillant C, Schwarzer G, Trelle S, Seidenfeld J, et al. Recombinant human erythropoiesis-stimulating agents and mortality in patients with cancer: a meta-analysis of randomised trials. Lancet. 2009; 373:1532-42.
van der Meer P, Groenveld HF, Januzzi JL Jr, van Veldhuisen DJ. Erythropoietin treatment in patients with chronic heart failure: a meta-analysis. Heart. 2009; 95:1309-14.
Wen Y, Xu J, Ma X, Gao Q. High-Dose Erythropoietin in Acute ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials. Am J Cardiovasc Drugs. 2013; 13:435-42.
Vlachopanos G, Kassimatis T, Agrafiotis A. Perioperative administration of high-dose recombinanthuman erythropoietin for delayed graft function prevention in kidney transplantation: a meta-analysis. Transpl Int. 2015; 28:330-40.
Xin H, Ge YZ, Wu R, Yin Q, Zhou LH, Shen JW, et al. Effect of high-dose erythropoietin on graft function after kidney transplantation: A meta-analysis of randomized controlled trials. Biomed Pharmacother. 2015; 69: 29-33.
- Abstract Viewed: 268 times
- pdf/5399 Downloaded: 116 times