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Updated: Jun 27, 2026
Intrafemoral Injection of Human Hematopoietic Stem and Progenitor Cells into Immunocompromised Mice
Published on: December 8, 2023
[Renal insufficiency after allogeneic stem cell transplantation in children]
Itaru Kato1, Katsutsugu Umeda, Hiroshi Matsubara
1Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto.
Insights
Hematopoietic stem cell transplantation (HSCT) can lead to renal insufficiency (RI) in children. Older children and those with early severe creatinine increases face higher risks for chronic RI.
Area of Science:
- Pediatric Hematology
- Nephrology
- Transplantation Medicine
Context:
- Hematopoietic stem cell transplantation (HSCT) is a critical treatment for pediatric hematological and non-malignant diseases.
- Renal insufficiency (RI) is a potential complication following HSCT, impacting patient outcomes.
- Understanding RI risk factors is crucial for improving post-transplant care in pediatric populations.
Purpose:
- To retrospectively evaluate the incidence of acute and chronic renal insufficiency (RI) after first HSCT in pediatric patients.
- To identify risk factors associated with the development of RI in this cohort.
- To inform strategies for RI prophylaxis and management in pediatric HSCT recipients.
Summary:
- This study analyzed 27 pediatric HSCT cases, finding an acute RI incidence of 51.9% and chronic RI of 22.2%.
- Key risk factors for chronic RI included patient age over 13 years and a significant serum creatinine increase (>3x) during the acute phase post-HSCT.
- Conditioning regimen intensity, TBI dose, GVHD prophylaxis, and GVHD grade did not significantly influence RI incidence.
Impact:
- Identifies older pediatric patients and those with early severe creatinine elevation as high-risk groups for chronic RI post-HSCT.
- Highlights the need for targeted renal insufficiency prophylaxis, such as ACE inhibitors or AII receptor antagonists.
- Provides evidence to guide clinical practice in managing and preventing renal complications in pediatric HSCT.
Abstract:
We retrospectively evaluated the incidence of renal insufficiency (RI) and risk factors involved in RI in 27 pediatric cases that underwent their first hematopoietic stem cell transplantation (HSCT) in our hospital. Median patient age was 7 years (7 months-16 years); 19 cases demonstrated hematological malignant disease and 8 cases showed non-malignant disease, respectively. Nineteen cases were transplanted from unrelated donors. The incidence of acute and chronic RI was 51.9% and 22.2%, respectively. The intensity of the conditioning regimen, the dose of TBI, GVHD prophylaxis, and the grade of GVHD did not significantly affect the incidence of either acute or chronic RI. Patients over 13 years old were at high risk for chronic RI. Furthermore, the incidence of chronic RI was significantly higher in patients showing a serum creatinine increase during the acute phase of HSCT that was more than three times the pre-HSCT level. RI prophylaxis such as ACE inhibitors or AII receptor antagonists is needed for older children and for those demonstrating severe RI at the early stage after HSCT.
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