Kidney and Blood Pressure Outcomes in Children Surviving at Least 6 Months after Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis

Pediatric hematopoietic stem cell transplantation (HSCT) recipients are at risk of developing kidney and high blood pressure (BP) conditions, but the prevalence of these conditions is unclear. We aimed to evaluate (1) the proportion of patients with late kidney and high BP outcomes after pediatric HSCT, (2) the relationship between acute kidney injury ≤100 days post-HSCT as a risk factor for these outcomes, and (3) types of outcome definitions outcomes used in the literature. We searched for studies reporting kidney and high BP outcomes at ≥6 months post-pediatric HSCT between January 2000 and November 2022. Categorical and continuous outcome measures were collected. Meta-analyses of pooled proportions stratified by HSCT indication were performed using random-effects models. A total of 54 studies were examined, including 41 (75.9%) that evaluated late kidney outcomes and 24 (44.4%) that evaluated high BP outcomes. The pooled proportions of patients with late kidney and high BP outcomes were 15.0% (95% confidence interval [CI], 0.11-0.20; I² = 91.7%) and 14.0% (95% CI, 0.09-0.19, I² = 93.4%), respectively. The highest proportions were observed in HSCT for malignancies. Definitions of kidney and high BP outcomes sometimes were undefined and varied greatly. Late kidney and BP complications are common in pediatric HSCT patients; however, current follow-up guidelines for pediatric HSCT survivors likely are inadequate to optimize detection and treatment of kidney and BP issues.