A Patient with Severe Post-transplant Anemia Due to Parvovirus B19 Infection Treated with Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitor (HIF-PHI): Desidustat

Introduction: Anemia is a common complication following kidney transplantation, influenced by factors such as immunosuppressive medications, increased susceptibility to infections, hemorrhage, nutritional deficiencies, reduced erythropoietin levels, hyperparathyroidism, and specific post-transplant medications. Case Description: A 52-year-old male with h/o T2DM, hypertension & ESKD underwent a deceased donor kidney transplant in March, 2023. Postoperatively, the patient developed anemia with an initial Hb level of 9.3 g/dl, with a declining trend. By May 2023, Hb had dropped to 5.8 g/dl, with normocytic normochromic anemia, normal iron/B12 levels & Stool OB -ve. A Bone Marrow Aspiration revealed pure red cell aplasia & giant proerythroblasts with features of “Lantern” cells of Parvovirus B19 infection. Diagnosis was confirmed by detection of B19 DNA through NAAT. Multiple interventions including blood transfusions (x8 units), IVIg at recommended doses, lowering TAC dose, adding everolimus at low dose, reducing steroid/MMF doses, adding erythropoietin inj, were ineffective in sustaining Hb levels (see Fig). In Nov-2023, Desidustat (Oxemia®), an oral hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), was started at 100mg 3/wk. Initial improvement in Hb to 8.3 g/dl was observed but was not sustained. The Desidustat dose was subsequently increased to 400mg/wk, resulting in improvement in Hb. By Feb 2024 Hb had increased to 11.1 gm/dl & by Mar 2024, Hb had stabilized at 13 g/dl. The Transplant kidney function remained stable with the serum creatinine of 1.01 mg/dl upon last review in March 2024. Discussion: This case illustrates the potential efficacy of Desidustat in managing refractory post-transplant anemia, particularly in complex cases involving Parvovirus B19-related anemia and is the first description noted in literature for this particular indication. The observed sustained improvement in Hb with adjusted dosing of Desidustat suggests a promising therapeutic avenue that warrants further research to optimize dosing and ensure long-term efficacy.