Long-term kidney side effects of allogeneic hematopoietic stem cell transplantation in children

Hematopoietic stem cell transplantation (HSCT) is an effective treatment for various childhood diseases with long-term complications, including kidney side effects.

We conducted a single-center retrospective study of 213 patients who received allogeneic HSCT between February 2011 and December 2023. Patients were followed for at least 3 months post-HSCT, with a median follow-up of 2.9 years. We evaluated pre- and post-HSCT estimated glomerular filtration rate (eGFR) and kidney complications.

After HSCT, patients showed significantly higher rates of acute kidney injury (21.6% vs. 4.1% pre-HSCT), hypertension (26.8% vs. 5.2% pre-HSCT), and tubulopathy (20.2% vs. 5.2% pre-HSCT). The median final eGFR was 144 mL/min/1.73 m², which was significantly lower than the pre-HSCT eGFR (155 mL/min/1.73 m², p < 0.0001) and negatively correlated with time after HSCT (Rs =  - 0.177, p = 0.009). Eight patients (3.8%) progressed to chronic kidney disease (CKD). Factors linked to CKD included inherited bone marrow failure syndromes, anti-thymocyte globulin (ATG) conditioning, urinary tract infections (UTIs), and high urinary BK virus loads. Although the rates of glomerular hyperfiltration (GHF) did not change significantly between pre-HSCT (63.8%) and post-HSCT (62.4%, p = 0.824), GHF was notable in patients with acute lymphoblastic leukemia pre-HSCT and thalassemia post-HSCT. Seventeen patients (8.4%) needed ongoing antihypertensive treatment.

HSCT can cause various kidney complications. GHF is common both before and after transplant, and eGFR often declines over time. UTIs, ATG conditioning, and inherited bone marrow failure syndromes are important risk factors for CKD. Individual factors and infection surveillance should be considered in these patients to approach kidney health.