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Optimizing iron therapy in children following kidney transplantation

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Created On: 18/11/2025

Anemia is a frequent complication in children after kidney transplantation, often driven by iron deficiency (ID).

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Key take away

Ferric carboxymaltose safely and effectively corrects iron deficiency and anemia in pediatric kidney transplant recipients, offering a dependable alternative when oral iron therapy falls short.

Background

Anemia is a frequent complication in children after kidney transplantation, often driven by iron deficiency (ID). Conventional oral iron therapy is commonly ineffective, creating a need for reliable alternatives. Ferric carboxymaltose (FCM), an intravenous formulation, has shown benefits in adults, but evidence in pediatric transplant patients is limited. Hence, researchers conducted a retrospective study to evaluate the safety and efficacy of FCM in managing ID and iron deficiency anemia (IDA) among pediatric kidney transplant recipients (KTR).

Method

The study included pediatric KTRs with ID or IDA who received FCM between Dec 2016 and Nov 2022. Patients were diagnosed according to KDIGO guidelines. Ferritin, transferrin saturation percentage (TSAT), and hemoglobin levels were measured at baseline and monitored at 1, 3, 6, and 12 months after FCM administration. Phosphate levels and adverse events were also assessed throughout follow-up.

Result

A total of 15 pediatric KTRs were treated with FCM; among them, 10 had both ID and IDA. Over a median follow-up of nearly 42 months, FCM consistently improved key hematological parameters.

Hemoglobin: Levels rose steadily, with median gains of 1.2–1.4 g/dL observed across all follow-up points.
Iron stores: Ferritin increased significantly and remained elevated for up to six months, while TSAT showed marked improvement within the first 30 days.
Phosphate levels: The concentrations were stable and showed no decline throughout follow-up.
Safety: No adverse reactions were recorded.

Collectively, it underscored that FCM not only corrected anemia but also maintained iron balance without compromising safety in this pediatric transplant population.

Conclusion

The study confirms that FCM effectively restores iron balance and improves hemoglobin levels in pediatric KTRs, with an excellent safety profile. These findings support its potential as a standard adjunct therapy and highlight the importance of further research to establish long-term outcomes in this population.