Long-term renal function after hemopoietic stem cell transplantation in children

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.