A multicenter, retrospective study of acute kidney injury in adult patients with nonmyeloablative hematopoietic SCT

H, Liu; Yf, Li; Bc, Liu; Jh, Ding; Ba, Chen; Wl, Xu; Qian, Jun

doi:10.1038/bmt.2009.99

Cited by 51 publications

(48 citation statements)

References 21 publications

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“…70,74,77,78 Mortality rates are often elevated in the most severe form of TA-TMA, 72 whereas milder cases present an increased risk for CKD. 66 As in the general population, diabetes mellitus, 32 previous hypertension, 26 previous renal impairment, 79 sepsis, 13 amphotericin use, 80 requirement for mechanical ventilation 33 and admission to the intensive care unit 26 were all associated with increased risk for AKI following HCT. In actual fact, pre-HCT comorbidities greatly impact the outcome of patients undergoing HCT.…”

Section: Pathogenesismentioning

confidence: 99%

“…51 In fact, hepatic SOS has been consistent in heralding AKI in myeloablative allogeneic HCT. Regarding nonmyeloablative HCT, one study has also described SOS as being an independent risk factor for the development of AKI 13 although SOS is exceptionally rare in non-myeloablative HCT. This injury causes obliteration of small intrahepatic venules and sinusoidal thrombosis, ultimately resulting in sinusoidal congestion, fibrosis and necrosis.…”

Section: Pathogenesismentioning

confidence: 99%

“…Acute GVHD is independently linked with an increased risk of the occurrence of AKI in both myeloablative and non-myeloablative conditioning regimens. 13,25,32,61 Although in GVHD all organs should be possible targets for donor T cells, the kidney as a target organ for acute GVHD is still not considered by many physicians. Furthermore, histologically confirmed diagnosis of renal GVHD is rarely done and pathologic criteria have not yet been established for renal involvement in acute GVHD.…”

Section: Pathogenesismentioning

confidence: 99%

“…The HCT-specific comorbidity index, which stratifies patients according to the severity of pre-HCT hepatic, pulmonary, cardiac and renal impairment and assesses the presence of prior solid tumors, has been shown to predict non-relapse mortality and overall survival of HCT patients, as well as post-HCT AKI. 81,82 Common risk factors for AKI specifically related with myeloablative regimens were hepatic SOS, 61,80,83 lung toxicity, 25 high-risk disease 32 and acute GVHD, 26 while previous myeloablative HCT, 25,84 high-risk disease, 84 acute GVHD, 13,25,32 CMV reactivation, 25 incomplete HLA-matched transplant, 13 MTX, 32 as well as the need for more than three lines of therapy before HCT 32 significantly increased the risk for the development of AKI in patients undergoing nonmyeloablative HCT (Table 2). OUTCOME Several studies have evidenced poorer early outcomes for AKI patients compared with those without renal dysfunction, 85,86 specifically longer lengths of intensive care unit and hospital stay, higher in-hospital and post-discharge mortality, and an increased likelihood of discharge to an extended care facility.…”

Section: Pathogenesismentioning

confidence: 99%

“…8 Although these classifications allowed for the identification of a significant number of patients as having AKI after myeloablative and non-myeloablative HCT, and performed well in predicting patient outcome, the advantages of each one over the other remain to be established in this setting. [9][10][11][12][13] The KDIGO classification system 14 (Table 1) proposed in 2012 resulted from the fusion of the former classifications (RIFLE and AKIN) as a means to establish one classification of AKI for clinical practice, research and public health. In the HCT setting, the KDIGO classification has not yet been prospectively evaluated, and it has only been employed in a recently published retrospective study of a small cohort of critically-ill allo-HCT patients.…”

Section: Definition and Diagnosismentioning

confidence: 99%

See 4 more Smart Citations

Acute kidney injury in HCT: an update

Lopes

Jorge

Neves

2016

Bone Marrow Transplant

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Acute kidney injury (AKI) is highly prevalent whether the patients undergo myeloablative or non-myeloablative hematopoietic cell transplantation (HCT); however, the pathogenesis and risk factors leading to AKI can differ between the two. The prognosis of AKI in patients receiving HCT is poor. In fact, AKI following HCT is associated not only with increased short-and long-term mortality, but also with progression to chronic kidney disease. Herein, the authors provide a comprehensive and up-to-date review of the definition and diagnosis, as well as of the incidence, pathogenesis and outcome of AKI in patients undergoing HCT, centering on the differences between myeloablative and non-myeloablative regimens. INTRODUCTIONHematopoietic cell transplantation (HCT) is currently used to treat numerous malignant (for example, multiple myeloma, leukemias and lymphomas) and non-malignant hematological disorders (for example, aplastic anemia, b-thalassemia, immunodeficiency disorders and inborn errors of metabolism), as well as solid tumors (for example, breast cancer and neuroblastoma), which are in other instances incurable.The two major HCT procedures, taking into consideration the conditioning regimen used, are myeloablative autologous and allogeneic HCT and non-myeloablative allogeneic HCT. On the one hand, myeloablative HCT utilizes the maximally tolerated dose of TBI with or without chemotherapy, or with chemotherapy alone. On the other hand, non-myeloablative HCT depends more on donor cellular immune effects and less on the cytotoxic effects of the preparative regimen to control the underlying disease. 1,2 It ultimately uses a lower dose conditioning regimen and can thus be offered to older patients, to those debilitated by additional comorbidities, or to high-risk, heavily pretreated patients, who would not tolerate myeloablative HCT, resulting in a consequent decrease in regimen-related toxicity and treatment-related mortality. [3][4][5] Acute kidney injury (AKI) is highly prevalent whether the patients undergo myeloablative or non-myeloablative regimens; however, the pathogenesis and risk factors leading to AKI can differ between the two. In fact, AKI in patients receiving HCT is associated not only with increased short-and long-term mortality as compared with patients with no AKI, but also with a higher rate of progression to chronic kidney disease (CKD). Herein, the authors provide a comprehensive and up-to-date review of the definition and diagnosis of AKI as well as of the incidence, risk factors, pathogenesis and outcome of AKI in patients undergoing HCT, centering on the differences between myeloablative and nonmyeloablative regimens.

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