Acute Kidney Injury After Pediatric Hematopoietic Stem Cell Transplantation: Incidence, Risk Factors, and Outcomes

Area of Science:

• Pediatric Hematology
• Nephrology
• Transplantation Medicine

Background:

• Acute kidney injury (AKI) is a common complication following pediatric hematopoietic stem cell transplantation (HSCT), associated with increased mortality and long-term kidney issues.
• Existing data on clinical factors influencing HSCT-associated AKI are inconsistent.

Purpose of the Study:

• To investigate the incidence, clinical determinants, and outcomes of AKI in pediatric HSCT recipients.
• To identify predictors of AKI and its association with chronic kidney disease (CKD) post-HSCT.

Main Methods:

• Retrospective cohort study of pediatric patients undergoing HSCT (March 2019-March 2023).
• AKI diagnosis based on KDIGO criteria using serum creatinine.
• Multivariable analysis using Firth penalized logistic regression to identify independent AKI predictors.

Main Results:

• AKI occurred in 26% of patients (18/68), with a median follow-up of 23.7 months.
• Older age was the sole independent predictor of AKI (adjusted OR=1.40 per year).
• Most AKI episodes (66.7%) occurred within 100 days post-HSCT, often triggered by infection; severe AKI (KDIGO stage 2-3) was linked to GVHD and was fatal. All patients who developed CKD had prior AKI.

Conclusions:

• Pediatric HSCT-AKI presents a bimodal risk: frequent mild episodes early post-transplant, and rare but fatal severe episodes later, associated with GVHD.
• Older age is a key risk factor for AKI post-HSCT.
• A history of AKI is strongly associated with the development of CKD, highlighting the need for risk-based monitoring and early nephrology consultation in high-risk patients.