Anemia status at 1-year post-kidney transplant was documented retrospectively in 231 pediatric recipients (mean age: 12.6 +/- 5.0, range: 1.9-20.7 years) at Cincinnati Children's Hospital Medical Center between 1978 and 2003. Anemia was present in 59 (25.5%) patients. The prevalence of anemia has increased in the more recent eras (1978-1985: 7.8%, 1986-1997: 29%; 1998-2003: 32%, p < 0.01). Logistic regression analysis determined that the use of calcineurin inhibitors or impaired allograft function predicted anemia at 1-year post-transplant. Kaplan-Meier analysis showed that children with anemia at 1-year post-transplant had a significantly worse overall allograft survival than children without anemia (p = 0.02). However, when data were analyzed using a Cox proportional hazards model, only lower allograft function at 1-year post-transplant, black race and older era, but not anemia, independently predicted worse graft survival in children. This study suggests that the recent increase in the incidence of anemia post-kidney transplant is related to modern immunosuppressive therapy and that post-transplant anemia is more likely a marker of allograft dysfunction in children rather than its cause.