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Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (4): 729-737. doi: 10.19723/j.issn.1671-167X.2026.04.008

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Incidence and associated factors of anemia within six months after kidney transplantation in pediatric recipients

Wenlin LI, Lei YU, Wenbo YANG, Jiankang DONG, Yujie YANG, Zhao ZHAO, Jianfei WANG, Weiyu ZHANG*(), Qiang WANG*()   

  1. Department of Urology, Peking University People' s Hospital; Peking University Institute of Organ Transplantation; Institute of Applied Lithotripsy Technology, Peking University; Beijing 100044, China
  • Received:2026-02-09 Online:2026-08-18 Published:2026-05-06
  • Contact: Weiyu ZHANG, Qiang WANG
  • Supported by:
    the National Natural Science Foundation of China(82570886); Peking University People' s Hospital Research and Development Fund(RDGS2023-09)

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Abstract:

Objective: Anemia is a common complication following kidney transplantation in children, yet its epidemiological characteristics and associated factors are not fully understood. This study aimed to investigate the incidence and clinical features of anemia within six months after pediatric kidney transplantation and to identify its associated factors, thereby providing evidence for management. Methods: A single-center retrospective cohort study was conducted on pediatric patients who underwent kidney transplantation at Peking University People' s Hospital from January 2022 to August 2025. Demographic, perioperative, and serial laboratory data up to 6 months post-transplantation were collected. Anemia was diagnosed according to the World Health Organization (WHO) age-specific criteria. Univariate analysis, multivariate binary Logistic regression, and receiver operating characteristic (ROC) curve analysis were performed to identify associated factors and assess their diagnostic value. Results: The study included 46 pediatric recipients. The incidence of anemia within 6 months post-transplantation was 41.3% (19/46), with normocytic anemia being the most prevalent type (63.1%, 12/19). Multivariate binary Logistic regression analysis showed that age (OR=0.293, P=0.018), postoperative serum urea at 6 months (OR=3.281, P=0.006), and estimated glomerular filtration rate (eGFR) (OR=0.893, P=0.030) were independently associated with anemia. Exploratory stratified analysis suggested that age < 13 years, serum urea >7 mmol/L, and eGFR < 120 mL/(min·1.73 m2) might serve as reference thresholds for clinical screening. ROC curve analysis indicated that postoperative serum urea had the best diagnostic value for anemia (area under the curve=0.890, P < 0.001). Hemoglobin levels began to differ significantly between the anemic and non-anemic groups from the third month postoperative onward, with the gap widening over time. Conclusion: This study demonstrates a high incidence of early-onset anemia after pediatric kidney transplantation, primarily mild to moderate normocytic anemia. It is associated with younger age and suboptimal allograft function, with the divergence in hemoglobin levels becoming apparent from the third month postoperative. Close monitoring of high-risk children, particularly those aged < 13 years or with serum urea >7 mmol/L and eGFR < 120 mL/(min·1.73 m2), and early intervention may help reduce the occurrence or severity of post-transplant anemia.

Key words: Child, Kidney transplantation, Anemia, Urea, Glomerular filtration rate

CLC Number: 

  • R699.2

Table 1

Baseline clinical and demographic characteristics of pediatric kidney transplant recipients"

Items Values
Demographic characteristics
  Age/years 11.8±3.2
  Gender (male) 28 (60.9)
  Height/cm 147.3±19.9
Weight/kg 36.6±13.5
  BMI/(kg/m2) 16.4±3.2
Etiology of end-stage renal disease
  Glomerular disease 10 (21.7)
  Hereditary kidney disease 7 (15.2)
  CAKUT 6 (13.0)
  Tubulointerstitial disease 2 (4.3)
  Neoplastic kidney disease 1 (2.2)
  Unknown 20 (43.5)
Preoperative renal replacement therapy
  HD 16 (34.8)
  PD 20 (43.5)
  Both HD and PD 6 (13.0)
  No dialysis 4 (8.7)
Clinical indicators
  Hb/(g/L) 107.2±23.8
  Scr/(μmol/L) 756.7±266.4
  eGFR/[mL/(min·1.73 m2)] 8.7±5.7

Table 2

Changes of clinical data in pediatric patients after kidney transplantation"

Time points RBC/(×1012/L) Hb/(g/L) HCT/% MCV/fL MCH/pg MCHC/(g/L) RDW-CV/%
Preoperatively 3.6±0.9 107.2±23.8 32.3±7.5 89.0±6.8 29.6±2.4 332.5±15.5 13.4±1.4
1 month postoperatively 3.8±0.6 114.2±15.6 35.5±4.6 93.4±6.1 30.0±2.2 321.3±11.1 15.3±2.0
2 months postoperatively 4.2±0.5 124.0±14.0 37.8±4.3 89.4±6.1 23.3±2.2 328.2±11.3 13.2±1.0
3 months postoperatively 4.3±0.7 123.1±17.7 37.8±5.4 87.4±6.3 28.5±2.3 326.3±11.8 12.8±1.3
4 months postoperatively 4.4±0.6 123.5±16.1 38.0±4.7 85.8±6.0 27.9±2.4 325.4±11.8 12.7±1.2
5 months postoperatively 4.4±0.7 121.2±15.4 37.3±4.7 84.4±5.7 27.5±2.4 325.0±13.2 13.0±1.1
6 months postoperatively 4.5±0.6 122.4±14.1 37.8±4.4 83.6±5.7 27.1±2.2 324.3±12.7 13.2±1.3
Time points RDW-SD/fL Serum urea/(mmol/L) Scr/(μmol/L) eGFR/[mL/(min·1.73 m2)] UA/(μmol/L) Tacrolimus blood concentration/(μg/L)
Preoperatively 42.9±6.1 21.3±6.4 756.7±266.4 8.7±5.7 435.7±112.2
1 month postoperatively 51.5±7.4 7.8±2.8 67.5±23.8 130.8±29.8 302.2±108.2 11.1±4.3
2 months postoperatively 43.1±4.0 6.6±2.3 72.7±31.1 127.0±32.4 342.9±113.4 10.4±2.7
3 months postoperatively 40.5±3.8 7.1±5.2 77.2±59.4 129.0±35.4 340.2±106.6 9.3±2.0
4 months postoperatively 39.4±3.8 6.6±2.2 71.4±42.8 130.7±29.8 364.0±92.6 9.4±2.0
5 months postoperatively 37.8±3.6 6.9±3.1 70.7±46.4 132.7±32.4 368.1±81.8 9.4±3.1
6 months postoperatively 39.9±3.8 6.7±2.8 73.2±62.9 133.7±33.7 367.8±94.8 9.2±2.8

Table 3

Univariate analysis of associated factors for PTA"

Variables PTA group Non-PTA group P value
Number of cases 19 27
Age/years, $\bar x \pm s$ (range) 11.2±3.4 (3-17) 12.3±3.0 (6-17) 0.222
BMI/(kg/m2), $\bar x \pm s$ 16.4±3.7 16.4±2.8 0.973
Gender, n (%) 0.337
  Male 10 (35.7) 18 (64.3)
  Female 9 (50.0) 9 (50.0)
Preoperative renal replacement therapy 0.368
  No dialysis 3 1
  HD 7 9
  PD 6 14
  Both HD and PD 3 3
Graft dysfunction 1 0 0.228
Viral infection 6 8 0.888
  BKV 4 8
  B19 1 0
  EBV 1 0
Postoperative complications, n (%)
  Myelosuppression 5 (26.3) 9 (33.3) 0.611
  Gout 10 (52.6) 15 (55.6) 0.845
  Renal osteodystrophy 9 (47.4) 12 (44.4) 0.845
  Hypothyroidism 4 (21.1) 5 (18.5) 0.831
  Hyperparathyroidism 3 (15.8) 6 (22.2) 0.588
  Perirenal hematoma 1 (5.3) 0 (0) 0.228
  Renal cyst 0 (0) 3 (11.1) 0.133
Preoperative indicators, $\bar x \pm s$
  MCHC/(g/L) 328.2±12.9 335.5±16.6 0.058
  MCH/pg 29.1±2.2 29.9±2.5 0.195
  MCV/fL 88.7±5.9 89.3±7.4 0.885
  RBC/(×1012/L) 3.6±2.4 3.7±0.9 0.859
  Hb/(g/L) 105.4±28.2 108.4±20.6 0.600
  HCT/% 32.1±8.4 32.4±6.9 0.780
  Serum urea/(mmol/L) 20.5±5.7 21.8±6.9 0.600
  Scr/(μmol/L) 721.5±294.2 781.6±247.8 0.289
  eGFR/[mL/(min·1.73 m2)] 9.4±5.4 8.2±5.9 0.489
  UA/(μmol/L) 415.3±115.2 450.1±109.9 0.300
Indicators at 6 months postoperatively, $\bar x \pm s$
  Serum urea/(mmol/L) 8.4±3.5 5.5±1.3 0.001
  eGFR/[mL/(min·1.73 m2)] 120.6±42.9 142.9±21.9 0.025
  Scr/(μmol/L) 94.1±93.0 58.6±17.7 0.058
  UA/(μmol/L) 371.4±72.5 365.3±109.1 0.832
  MCV/fL 82.9±5.4 84.2±6.0 0.624
  MCH/pg 26.9±2.2 27.3±2.3 0.584
  MCHC/(g/L) 324.6±11.9 324.2±13.4 0.893
  Tacrolimus blood concentration/(μg/L) 9.2±2.4 9.3±3.1 0.933

Table 4

Multivariate Logistic regression analysis of associated factors for PTA"

Variables B SE Wald P Exp (B) (95%CI)
Age -0.670 0.284 5.554 0.018 0.512 (0.293, 0.893)
Postoperative urea 1.188 0.435 7.465 0.006 3.281 (1.399, 7.695)
Postoperative eGFR -0.113 0.052 4.715 0.030 0.893 (0.807, 0.989)
Postoperative Scr -0.047 0.027 3.163 0.075 0.954 (0.906, 1.005)
Constant 118.005 110.220 3.104 0.078

Table 5

Stratified analysis of associated factors for PTA"

PTA group Non-PTA group P value
Age ≤5 years 1/18 0/27 0.228
Age ≤9 years 5/14 5/22 0.307
Age ≤13 years 16/3 14/13 0.032
Serum urea >7 mmol/L 9/10 1/26 < 0.001
eGFR < 120 mL/(min·1.73 m2) 7/12 2/25 0.037

Figure 1

Correlation analysis between transplanted kidney function and Hb level A, ROC curve; B, Pearson correlation analysis; C, Hb levels corresponding to different serum urea levels. ROC, receiver operating characteristic; eGFR, estimated glomerular filtration rate; Hb, hemoglobin."

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