Although use of human recombinant erythropoietin has alleviated symptoms of anemia in renal failure, effects of increased hematocrit (HCT) on early post-transplant renal function are unknown. Of 244 consecutive primary cadaveric kidney recipients transplanted over 74 months, 43% had HCT ≥ 30% and 57% had HCT < 30% at transplantation. The incidence of delayed graft function (DGF) was greater in recipients with HCT ≥ 30% (61%) than in recipients with HCT < 30% (33%; P=0.0001). Ten percent of recipients with HCT ≥ 30% experienced primary nonfunction (PNF) of the allograft (P=0.0001). No recipient with HCT < 30% had PNF. Absolute rises in HCT over the 3 months preceding transplantation were greatest in those with PNF (2.5±2.4) followed by those with DGF (2.0±3.1) and immediate graft function (IGF) (0.2±5.2; P=0.0328). Logistic regression analysis identified HCT ≥ 30% (P=0.0014), cold storage ≥ 24 hr (P=0.0006) and rising HCT (P=0.0090) as independent predictors of DGF with relative risks of 3.1-, 3.3-, and 2.7-fold, respectively. Recipients with rising pretransplant HCTs who underwent dialytic fluid removal within 24 hr before transplantation had DGF with greater frequency (67%) than nondialyzed recipients with rising HCTs (45%). Primary cadaveric kidney recipients with HCT ≥ 30% at transplantation have significantly greater risk for DGF and PNF. Rising pretransplant HCT levels may predispose recipients to DGF; this risk may be heightened in those undergoing hemodialysis shortly before transplantation.
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