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

Background and objectives 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-alpha) 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. Design, setting, participants, & measurements A prospective, randomized, double-blind, placebo-controlled clinical trial was conducted to evaluate the influence of EPO-alpha administered intraoperatively on the outcomes of DDK transplantations performed at the study center between March 2007 and July 2009. Results Seventy-two patients were randomly assigned to EPO-alpha (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. Conclusions This study did not show any clinically demonstrable beneficial effects of high-dose EPO-alpha 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. Clin J Am Soc Nephrol 7: 1498-1506, 2012. doi: 10.2215/CJN.01360212