Abstract
(1) Background: Acute kidney injury (AKI) is a serious complication of hematopoietic stem cell transplantation (HSCT). (2) Methods: The aim was to identify the incidence, severity, and risk factors for AKI during the first 100 days after allo-HSCT; we performed a prospective observational study on 135 consecutive patients. (3) Results: The mean age was 38.3 ± 11.9 years (50.6% females), AKI developed in 93 patients (68.9%), the median time of appearance was 28 days, and the mean serum creatinine at the time of AKI was 1.8 ± 0.8 mg/dL. A total of 36 (38.7%) patients developed stage 1 AKI, 33 (35.5%) patients developed stage 2, and 24 (25.8%) patients developed stage 3; eight (8.6%) patients required temporary hemodialysis, and the mortality rate in these patients was 87.5%. Death was twice as frequent in the AKI subgroup, without statistical significance. Cyclosporine overdose (HR = 2.36, 95% CI: 1.45–3.85, p = 0.001), tacrolimus overdose (HR = 4.72, 95% CI: 2.22–10.01, p < 0.001), acute graft-versus-host disease (aGVHD) (HR = 1.96, 95% CI: 1.13–3.40, p = 0.01), and CRP level (HR = 1.009, 95% CI: 1.007–1.10, p < 0.001) were independent risk factors for AKI. Sepsis (HR = 5.37, 95% CI: 1.75–16.48, p = 0.003) and sinusoidal obstruction syndrome (HR = 5.10, 95% CI: 2.02–12.85, p = 0.001) were found as independent risk factors for AKI stage 3. (4) Conclusions: AKI occurs with high incidence and increased severity after allo-HSCT. Careful monitoring of calcineurin inhibitors and proper management of sepsis may reduce this risk.
Highlights
Acute kidney injury (AKI) incidence depends on the type of transplant, conditioning regimen, and AKI definition [16]
In a previous study performed by our team, we found a 10% incidence of AKI in the first 30 days following autologous stem cell transplantation performed in patients with multiple myeloma [17], whereas in the present study we had an incidence of 41.4% in the first month
We found that CsA and TAC overdose were independent risk factors for AKI
Summary
Hematopoietic stem cell transplantation (HSCT) is a complex therapy with curative potential for an expanding array of diseases, both malignant and non-malignant. Data from the literature indicate that a milestone of 1.5 million HCSTs performed worldwide was reached in 2019 [1]. The rising number of allogeneic HSCTs (allo-HSCT) reported annually is paralleled by improved outcomes. Acute kidney injury (AKI) is a frequent complication among patients undergoing allogeneic HSCT. A recent, large cohort study found a 64% incidence during the first 100 days following the procedure, demonstrating a higher non-relapse mortality in the group experiencing kidney dysfunction [2]
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