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Prospective study of renal insufficiency after bone marrow transplantation
Joana E Kist-van Holthe1, Charlotte A Goedvolk, Ronald Brand
1Department of Pediatrics, Leiden University Medical Center, The Netherlands. joana@kist.nl
Insights
Acute kidney problems after pediatric bone marrow transplants (BMT) affect 21% of children. Risk factors include veno-occlusive disease and high cyclosporine levels. Chronic kidney issues developed in 11% of survivors.
Area of Science:
- Pediatric Hematology Oncology
- Nephrology
- Transplant Medicine
Background:
- Allogeneic bone marrow transplantation (BMT) survival rates are increasing in children.
- Acute and late complications, including renal insufficiency, are significant concerns post-BMT.
- Understanding risk factors for renal complications is crucial for improving outcomes.
Purpose of the Study:
- To identify risk factors for acute and chronic renal insufficiency in children undergoing allogeneic BMT.
- To assess the incidence of renal insufficiency post-BMT in a pediatric cohort.
- To compare findings with adult BMT studies regarding renal complications.
Main Methods:
- Prospective study of 66 children receiving allogeneic BMT over a 2-year period.
- Data collection on acute and chronic renal insufficiency incidence and potential risk factors.
- Statistical analysis to determine significant predictors of renal insufficiency.
Main Results:
- 21% of children developed acute renal insufficiency post-BMT.
- Veno-occlusive disease, high cyclosporine serum levels, and foscarnet therapy were identified as risk factors for acute renal insufficiency.
- 11% of surviving patients developed chronic renal insufficiency 1 year post-BMT, with acute renal insufficiency being the sole predictor.
- Total body irradiation was not found to be a risk factor for chronic renal insufficiency in this pediatric cohort.
Conclusions:
- Acute renal insufficiency is a common complication following pediatric allogeneic BMT.
- Specific factors like veno-occlusive disease and certain medications increase the risk of acute renal insufficiency.
- Acute renal insufficiency is a key predictor for developing chronic renal insufficiency post-BMT in children.
- Long-term studies are necessary to fully understand the long-term renal morbidity in pediatric BMT survivors.
Abstract:
Since more and more children survive allogeneic bone marrow transplantation (BMT), knowledge of acute and late complications becomes increasingly important. Besides the major complications [(opportunistic) infections, veno-occlusive disease, graft versus host disease, and recurrence of primary disease], acute and chronic renal insufficiency are significant post-transplant complications that may contribute to transplant-related mortality. To elucidate risk factors for acute and chronic renal insufficiency post BMT, we performed a prospective study of all 66 children who received a BMT in a 2-year period at our institution; 21% had acute renal insufficiency post BMT. Risk factors for acute renal insufficiency were veno-occlusive disease, high cyclosporin serum levels, and foscarnet therapy. Of surviving patients, 11% developed chronic renal insufficiency 1 year post BMT. Acute renal insufficiency was the sole predictor of chronic renal insufficiency. In contrast to studies in adults, we did not find total body irradiation to be a risk factor for chronic renal insufficiency. Future long-term studies are needed to assess incidence and morbidity of chronic renal insufficiency in children following allogeneic BMT.