Abstract
Acute kidney injury (AKI) is a common complication of allogeneic hematopoietic cell transplantation (allo-HCT) and is associated with non-relapse mortality (NRM) and quality of life (QOL). Multiple factors may contribute to AKI during allo-HCT and are often present at the same time making it difficult to determine the cause of AKI in each patient. Nephrotoxic drugs, infections, thrombotic microangiopathy (TMA), and sinusoidal obstruction syndrome (SOS) are well described causes of AKI during allo-HCT. Acute graft-versus-host disease (aGVHD) is a major complication of allo-HCT that mainly targets the intestines, liver, and skin. However, recent studies suggest aGVHD may also attack the kidney and contribute to AKI following allo-HCT. For example, severe aGVHD is associated with AKI, suggesting a link between the two. In addition, animal models have shown donor immune cell infiltration and increased expression of inflammatory cytokines in recipient kidneys after allo-HCT. Therefore, aGVHD may also target the kidney and contribute to AKI following allo-HCT. Herein, we describe the etiology, diagnosis, risk factors, pathophysiology, prevention, and treatment of renal injury after allo-HCT. In addition, we highlight emerging evidence that aGVHD may contribute to the development of AKI after allo-HCT.
Highlights
Hematopoietic cell transplantation (HCT) is a curative therapy for hematologic malignancies and many non-malignant diseases [1]
graft-versus-host disease (GVHD) was classified into acute GVHD if it developed within 100 days after transplantation or chronic GVHD if it developed after 100 days
In pediatric HCT recipient, the incidence of Acute kidney injury (AKI) is similar to adults [44, 48, 49, 56,57,58], AKI worsens mortality after HCT [49, 57], and the 1-year survival rate is less than 10% in patients with renal failure requiring renal replacement therapy [56]
Summary
Masahiro Miyata 1, Kazunobu Ichikawa 1*, Eri Matsuki 1, Masafumi Watanabe 1, Daniel Peltier 2 and Tomomi Toubai 3*. Advances of Acute Kidney Injury in Hematopoietic Cell Transplantation. Acute kidney injury (AKI) is a common complication of allogeneic hematopoietic cell transplantation (allo-HCT) and is associated with non-relapse mortality (NRM) and quality of life (QOL). Multiple factors may contribute to AKI during allo-HCT and are often present at the same time making it difficult to determine the cause of AKI in each patient. Acute graft-versus-host disease (aGVHD) is a major complication of allo-HCT that mainly targets the intestines, liver, and skin. Recent studies suggest aGVHD may attack the kidney and contribute to AKI following allo-HCT. AGVHD may target the kidney and contribute to AKI following allo-HCT. We highlight emerging evidence that aGVHD may contribute to the development of AKI after allo-HCT
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