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Competitive Transplants to Evaluate Hematopoietic Stem Cell Fitness
Published on: August 31, 2016
Long-term renal function after allogenic haematopoietic stem cell transplantation in adult patients: a single-centre
Maxime Touzot1, Caroline Elie, Jill van Massenhove
1Department of Nephrology, Université Paris Descartes, AP-HP, Necker Hospital, Paris, France.
Insights
Chronic kidney disease (CKD) affects 40% of patients post-hematopoietic stem cell transplant (HSCT). Risk factors include older age and pre-existing kidney issues, necessitating vigilant renal function monitoring.
Area of Science:
- Nephrology
- Hematology
- Transplantation Medicine
Background:
- Data on chronic kidney disease (CKD) following hematopoietic stem cell transplantation (HSCT) is inconsistent.
- A retrospective study assessed CKD incidence, risk factors, and outcomes in HSCT recipients.
Purpose of the Study:
- To determine the rate of CKD after allogeneic HSCT.
- To identify risk factors associated with HSCT-related CKD.
- To evaluate the long-term outcomes of CKD in HSCT patients.
Main Methods:
- Retrospective single-center study of 123 allogeneic HSCT patients.
- Assessed CKD using estimated glomerular filtration rate (GFR) <60 ml/min/1.73 m(2).
- Followed patients for over 36 months to evaluate CKD persistence and development.
Main Results:
- CKD was observed in 40% of patients at 24 months post-HSCT.
- Predictors of CKD included age ≥45 years, early acute kidney injury, and baseline GFR <90 ml/min/1.73 m(2).
- CKD persisted in 67% of affected patients, with early- and late-onset subsets identified.
Conclusions:
- Vigilant renal function monitoring is crucial for HSCT recipients.
- Particular attention should be paid to older patients with pre-existing renal impairment.
Background:
Reported data regarding chronic kidney disease (CKD) in haematopoietic stem cells transplantation (HSCT) recipients are highly discrepant. Materials and methods. We undertook a retrospective single-centre study in order to assess the rate, risk factors and outcome of HSCT-associated CKD in 123 allogeneic HSCT patients.
Results:
Twenty-four months after HSCT, CKD [e.g. glomerular filtration rate (GFR) estimated using the MDRD formula <60 ml/min/1.73 m(2)] was noted in 49 patients (40%). Age >or= 45 years, early acute kidney injury and a baseline GFR < 90 ml/min/1.73 m(2) predicted the occurrence of CKD at 24 months after HSCT. One hundred and six patients (45 with and 61 without CKD at 24 months) were followed up for more than 36 months (range 36-142). Among the 45 patients with CKD at 24 months after HSCT, CKD persisted in 30 (67%), 10 patients (22%) showed a transient improvement in GFR but retained CKD and 10 patients (22%) had a sustained improvement of GFR. Among 61 patients without CKD at 24 months after HSCT, 3 (5%) developed CKD during the follow-up. Our data indicate that HSCT-related CKD probably includes two subsets: a frequent early-onset CKD, a consequence of ARF in older patients with pre-existent renal impairment, and a rare late-onset CKD occurring more than 2 years following HSCT.
Conclusions:
Careful monitoring of renal function is mandatory in patients undergoing HSCT, especially old patients with pre-existent renal impairment.
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