Risk factors for acute kidney injury in pediatric patients after hematopoietic stem cell transplantation: a

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Baoyi Huang1, Jiayi Shan1, Lichen Yi1

  • 1Guangzhou University of Chinese Medicine, Guangzhou, China.

Pediatric Nephrology (Berlin, Germany)
|April 20, 2023
PubMed

Insights

Pediatric acute kidney injury (AKI) after hematopoietic stem cell transplantation (HSCT) is common. Unrelated donors, cord blood stem cell transplantation, and VOD/SOS are potential risk factors for AKI in children undergoing HSCT.

Area of Science:

  • Pediatric Hematology
  • Nephrology
  • Transplantation Medicine

Background:

  • Acute kidney injury (AKI) is a significant complication following hematopoietic stem cell transplantation (HSCT) in pediatric patients, with risk factors often debated.
  • Identifying these risk factors is crucial for improving patient outcomes and developing targeted interventions.

Approach:

  • A systematic review and meta-analysis was conducted, searching multiple databases (PubMed, Embase, Web of Science, Cochrane Library, Scopus) up to February 8, 2023.
  • Included studies were case-control, cohort, or cross-sectional designs involving pediatric patients (≤21 years) undergoing HSCT, with a minimum of ten patients.
  • Quality assessment and random-effect modeling were employed to synthesize data from fifteen high-quality cohort studies involving 2,093 patients.

Key Points:

  • The pooled incidence of AKI post-HSCT in children was found to be 47.4%.
  • Significant risk factors identified for AKI include the use of an unrelated donor (OR=1.74), cord blood stem cell transplantation (OR=3.14), and veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) (OR=6.02).
  • Factors such as myeloablative conditioning (MAC), acute graft-versus-host disease (aGVHD), and calcineurin inhibitors (CNI) were not significantly associated with AKI.

Conclusions:

  • Post-transplant AKI is a frequent complication in pediatric HSCT recipients.
  • Unrelated donors, cord blood stem cell sources, and VOD/SOS are identified as potential contributors to AKI.
  • Further extensive research is necessary to establish definitive conclusions due to heterogeneity in patient and transplantation characteristics.
Abstract

Keywords:
Acute kidney injuryHematopoietic stem cell transplantationPediatricsRisk factors

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