Abstract
BackgroundAcute kidney injury (AKI) remains a frequent complication in children undergoing hematopoietic stem cell transplantation (HSCT) and an independent risk factor of the patient’s survival and a prognostic factor of progression to chronic kidney disease (CKD). However, the causes of these complications are diverse, usually overlapping, and less well understood.MethodsThis retrospective analysis was performed in 43 patients (28 boys, 15 girls; median age, 5.5 years) undergoing HSCT between April 2006 and March 2019. The main outcome was the development of AKI defined according to the Pediatric Risk, Injury, Failure, Loss, End-stage Renal Disease (pRIFLE) criteria as ≥ 25% decrease in estimated creatinine clearance. The secondary outcome was the development of CKD after a 2-year follow-up.ResultsAKI developed in 21 patients (49%) within 100 days after HSCT. After adjusting for possible confounders, posttransplant AKI was associated with matched unrelated donor (MUD) (HR, 6.26; P = 0.042), but not total body irradiation (TBI). Of 37 patients who were able to follow-up for 2 years, 7 patients died, but none had reached CKD during the 2 years after transplantation.ConclusionsPosttransplant AKI was strongly associated with HSCT from MUD. Although the incidence of AKI was high in our cohort, that of posttransplant CKD was lower than reported previously in adults. TBI dose reduced, GVHD minimized, and infection prevented are required to avoid late renal dysfunction after HSCT in children since their combinations may contribute to the occurrence of AKI.
Highlights
Acute kidney injury (AKI) remains a frequent complication in children undergoing hematopoietic stem cell transplantation (HSCT) and an independent risk factor of the patient’s survival and a prognostic factor of progression to chronic kidney disease (CKD)
Both acute graft-versus-host disease (GVHD) and sinusoidal obstruction syndrome (SOS) were considered valid only if they developed before AKI and were included in our analysis to evaluate their effects on AKI
Stem cells for transplantation were obtained from bone marrow (n = 19, 44%), peripheral blood (n = 21, 49%), or cord blood (n = 3, 7%), and were from autologous (n = 20, 46%), matched related donor (MRD), (n = 5, 12%), and matched unrelated donor (MUD) (n = 18, 42%) as the source
Summary
Acute kidney injury (AKI) remains a frequent complication in children undergoing hematopoietic stem cell transplantation (HSCT) and an independent risk factor of the patient’s survival and a prognostic factor of progression to chronic kidney disease (CKD). The risks of chronic kidney disease (CKD), as well as short- and long-term mortality rates, are increased in patients who develop acute kidney injury (AKI) following hematopoietic stem cell transplantation (HSCT). AKI continues to show adverse health effects after hospital discharge, and the risks of CKD and long-term mortality were reported to be greater in patients with than without AKI [1]. Kidney injury remains a significant complication of HSCT, negatively affecting patients’ quality of life (QOL) and both early and long-term mortality rates. To improve transplant outcomes, it is important to determine risk factors, understand the causes, and develop methods for the early diagnosis and treatment of kidney injury
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