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Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
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Nephrotoxicity in CAR-T Cell Therapy.

Karol Sadowski1, Weronika Ploch1, Alicja Downar1

  • 1Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.

Transplantation and Cellular Therapy
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Summary

Chimeric antigen receptor (CAR)-T cell therapy, while effective for blood cancers, can cause kidney injury. This review examines CAR-T cell-associated nephrotoxicity, its risk factors, and impact on treatment outcomes.

Keywords:
Acute kidney injuryCAR-T cellsChronic kidney diseaseCytokine release syndrome

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Area of Science:

  • Oncology
  • Immunology
  • Nephrology

Background:

  • Chimeric antigen receptor (CAR)-T cell therapy offers a promising treatment for hematologic malignancies.
  • CAR-T cell therapy is known for significant toxicities like cytokine release syndrome (CRS) and neurotoxicity.
  • Nephrotoxicity is an emerging concern with CAR-T cell therapy, receiving less attention to date.

Purpose of the Study:

  • To review the incidence and association between CAR-T cell therapy and kidney injury.
  • To elucidate risk factors, biomarkers, and potential mechanisms of acute kidney injury (AKI) and chronic kidney disease (CKD) following CAR-T cell therapy.
  • To explore the impact of nephrotoxicity on CAR-T cell efficacy and the safety of lymphodepletion in patients with pre-existing kidney conditions.

Main Methods:

  • Literature review focusing on CAR-T cell therapy and renal impairment.
  • Analysis of reported cases and studies on CAR-T cell-associated nephrotoxicity.
  • Synthesis of information on risk factors, biomarkers, pathomechanisms, and clinical outcomes.

Main Results:

  • CAR-T cell therapy is associated with varying degrees of kidney injury, including AKI and CKD.
  • Identified risk factors and potential biomarkers for predicting and monitoring CAR-T cell-induced nephrotoxicity.
  • Explored the link between renal impairment and other CAR-T cell toxicities, as well as its effect on therapeutic efficacy.

Conclusions:

  • Kidney injury is a significant, albeit under-recognized, toxicity of CAR-T cell therapy.
  • Understanding nephrotoxicity mechanisms is crucial for improving patient safety and treatment outcomes.
  • Further research is needed to optimize management strategies for CAR-T cell therapy in patients with kidney compromise.