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Long-term renal function after hemopoietic stem cell transplantation in children
J E Kist-van Holthe1, D Bresters, Y M Ahmed-Ousenkova
1Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. j.kist@lumc.nl
Bone Marrow Transplantation
|July 27, 2005
Summary
Long-term survivors of hemopoietic stem cell transplantation (HSCT) show improved renal function in recent cohorts. Chronic renal failure (CRF) rates decreased post-HSCT, with high pre-transplant creatinine as the main predictor.
Area of Science:
- Nephrology
- Hematology
- Pediatric Oncology
Background:
- Hemopoietic stem cell transplantation (HSCT) is a life-saving procedure.
- Long-term complications, including renal dysfunction, require ongoing monitoring.
- Previous studies indicated a significant risk of chronic renal failure (CRF) post-HSCT.
Purpose of the Study:
- To evaluate long-term glomerular and tubular function in pediatric HSCT survivors.
- To compare renal function outcomes between older and newer HSCT cohorts.
- To identify predictors of chronic renal failure (CRF) after HSCT.
Main Methods:
- Retrospective analysis of 121 patients (1991-1998) and prospective analysis of 41 children (1998-2000) undergoing HSCT.
- Assessment of glomerular and tubular function at long-term follow-up.
- Statistical analysis to identify predictors of CRF.
Main Results:
- Lower prevalence of CRF in the recent cohort (10%) compared to the older cohort (24%).
- Renal function appeared to stabilize after 1 year post-HSCT.
- High pre-HSCT serum creatinine was the sole predictor of CRF; acute renal failure showed a trend.
- No association found between irradiation conditioning and CRF.
- Tubular dysfunction occurred in a minority and had no clinical impact.
Conclusions:
- Recent HSCT protocols are associated with a reduced risk of chronic renal failure.
- Pre-transplant renal function is a critical factor in predicting post-HSCT renal outcomes.
- Long-term renal function in HSCT survivors is generally stable and does not typically require dialysis or antihypertensive medication.