Outcome predictors of allogeneic hematopoietic stem cell transplant

Acute kidney injury (AKI) is a significant complication after hematopoietic stem cell transplantation (HSCT) and frequently limits treatment success. Patients suffering complications with AKI often have high mortality. This investigation analyzed the outcomes of patients receiving allogeneic HSCT and identified the association between prognosis and RIFLE (risk of renal failure, injury to kidney, failure of kidney function, loss of kidney function and end-stage renal disease) classification. This study reviewed the medical records of 101 patients receiving allogeneic HSCT during an 8-year period at a specialized hematology ward in a university hospital in Taiwan. Demographic, clinical and laboratory variables were retrospectively gathered as predicators. Overall 6-month mortality was 36.6% (37/101). Mortality progressively and significantly increased (χ for trend, P < 0.001) based on RIFLE classification severity. Multiple variable Cox regression analysis identified maximum RIFLE score on day 7 to 14 post-HSCT, occurrence of hepatic veno-occlusive disease and respiratory failure during admission as independent risk factors for 6-month mortality. Using the area under the receiver operating characteristic curve, the RIFLE classification on day 7 to 14 post-HSCT has the best discriminative power (area under the receiver operating characteristic curve: 0.696 ± 0.057, P < 0.001) compared with day 0 to 7, 14 to 30 and 30 to 60 post-HSCT. Cumulative survival rates at 6-month follow-up differed significantly (P < 0.05) among non-AKI, RIFLE-R versus RIFLE-I and RIFLE-F. Hepatic veno-occlusive disease, respiratory failure and severity of maximum RIFLE score on day 7 to 14 post-HSCT were independent predictors for 6-month mortality. RIFLE classification on day 7 to 14 post-HSCT can improve the accuracy of 6-month mortality in patients who received allogeneic HSCT.