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Updated: Jul 1, 2026
Murine Kidney Transplant Technique
Published on: October 20, 2015
Acute kidney injury in pediatric stem cell transplant recipients
Joseph DiCarlo1, Steven R Alexander
1Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. jdicarlo@chla.usc.edu
Insights
A proactive approach to managing fluid overload after hematopoietic stem cell transplantation can prevent acute respiratory distress syndrome. Early intervention with fluid management and renal replacement therapy improves patient outcomes.
Area of Science:
- Hematology
- Critical Care Medicine
- Transplantation Immunology
Background:
- Respiratory dysfunction post-hematopoietic stem cell transplantation (HSCT) is a continuum of transplant-induced dysfunction.
- Organ dysfunction in HSCT patients is driven by cytokine-mediated processes, often manifesting initially as fluid accumulation.
Purpose of the Study:
- To describe a proactive, multistep protocol to prevent or attenuate respiratory dysfunction progression to acute respiratory distress syndrome (ARDS) after HSCT.
- To outline an intervention strategy focusing on fluid balance control and early use of continuous renal replacement therapy (CRRT).
Main Methods:
- The protocol involves initial fluid intake restriction and augmentation of output via dopamine and furosemide infusions.
- Continuous renal replacement therapy (CRRT) is advocated early if fluid accumulation persists, indicated by >10% body weight increase, rising C-reactive protein, and increased oxygen demand.
- Renal function parameters are not primary triggers in this protocol.
Main Results:
- The recommended CRRT dose is 35 mL/kg/h (2,000 mL/1.73 m(2)/h) for fluid management flexibility and mediator clearance.
- This proactive intervention aims to improve clinical status, facilitating smoother transition to mechanical ventilation or potentially avoiding it altogether.
Conclusions:
- A proactive strategy targeting fluid balance is crucial for managing post-HSCT respiratory dysfunction.
- Early implementation of CRRT, guided by specific clinical markers, can mitigate progression to ARDS and improve patient outcomes.
Abstract:
Because respiratory dysfunction after hematopoietic stem cell transplantation is a manifestation of a continuum of dysfunction temporarily induced by the transplant process, a proactive rather than reactive approach might prevent or attenuate its progression to acute respiratory distress syndrome. Organ dysfunction in this population results from cytokine-driven processes, of which the first manifestation includes fluid accumulation. We describe a multistep protocol that first targets fluid balance control, both through restriction of intake and through augmentation of output using dopamine and furosemide infusions. If these steps fail to stem the tide of water accumulation, we advocate the relatively early use of continuous renal replacement therapy, its use triggered by a continued increase in body weight (>10% above baseline), an increasing c-reactive protein level, and an increasing oxygen need. Renal function parameters do not figure in this protocol. We recommend continuous renal replacement therapy at 35 mL/kg/h (2,000 mL/1.73 m(2)/h), a dose that allows adequate flexibility in fluid management and that may provide effective clearance of proinflammatory (and anti-inflammatory) mediators that drive the evolving dysfunction. Proactive intervention improves the clinical status such that the transition to mechanical ventilation may proceed smoothly or in some cases even may be avoided altogether.
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