Early Post-Kidney Transplant Treatment With Roxadustat Ameliorates Anemia and Reduces Blood Transfusion Needs in Inflamed Patients: A Case-Matched Study

Background: Roxadustat is an oral hypoxia-inducible factor prolyl-hydroxylase inhibitor. Recent studies have shown no inferiority of roxadustat compared to erythropoietin in chronic kidney disease and in post-transplant patients. We evaluated roxadustat versus erythropoiesis-stimulating agents (ESAs) in very early posttransplant patients. Methods: We performed a retrospective analysis of the clinical course and laboratory changes in posttransplant patients treated with roxadustat (16 patients) or a high-dose erythropoiesis-stimulating agent (ESA) (16 patients) for anemia between March and September 2025. We compared haemoglobin, creatinine, lipid levels, and iron status. The therapy was started after the kidney transplant, respectively, after a median of 3.5 and two days. Every patient was followed up at two weeks, one month, two months, and three months. Results: Patients treated with roxadustat showed a significantly greater and faster increase in Hb levels at 2 weeks (p = 0.047) than the ESA group. After 2 weeks, we observed a significant difference in the need for blood transfusions between the groups (p = 0.029; 18.8% in the roxadustat group vs. 62.5% in the ESA group). No significant differences were observed in iron or inflammation status during the study. The roxadustat group achieved a significantly better lipid profile after one month (p < 0.05 for cholesterol and LDL). During the follow-up, no adverse events related to roxadustat were reported. Conclusion: Administration of oral roxadustat in very early post-transplant patients is effective and safe, rapidly improving anemia and reducing the need for transfusions.