Acute kidney injury following HCT: incidence, risk factors and outcome

Abstract

Acute kidney injury (AKI) is a common complication in haematopoietic cell transplantation (HCT) patients and it adversely affects outcome. Herein, we provide a comprehensive and contemporary discussion of the incidence, risk factors and outcome of AKI in patients undergoing HCT, focusing on the differences between the myeloablative and nonmyeloablative regimens.

Risk factors for thrombotic microangiopathy in allogeneic hematopoietic stem cell recipients receiving GVHD prophylaxis with tacrolimus plus MTX or sirolimus

“…Moreover, this finding is consistent with the fact that an early diagnosis of TA-TMA is crucial in obtaining a faster response and a better clinical evolution of these patients, before the development of an acute kidney injury, as TA-TMA is one of the most common causes of chronic kidney disease after HSCT, which is supposed to be a worse survival in these patients. 32 In this regard, we have described for the first time the presence of circulating erythroblasts in all patients developing probable TMA. As previously reported by Oberic et al, 33 patients with cancerassociated TMAs had a typical presentation on diagnosis that was clearly distinct from that of idiopathic TMA.…”

Onco-Nephrology

“…Myeloablative autologous HCT has the lowest incidence of AKI (22%) (52,53), a difference that can be attributed to the lack of graft versus host disease (GVHD), the absence of calcineurin inhibitors, and more rapid engraftment in this population. Most cases of AKI occur within the first 100 days after HCT, with an earlier onset in myeloablative (7-40 days) compared with nonmyeloablative regimens (22-60 days) (14). Overall mortality rates in patients with AKI range from 37% to 46% and are as high as 88% in patients requiring dialysis (46,54).…”

“…Overall mortality rates in patients with AKI range from 37% to 46% and are as high as 88% in patients requiring dialysis (46,54). Importantly, AKI after HCT predicts the subsequent development of CKD in both myeloablative and nonmyeloablative HCT (14).…”

“…Although HCT offers a potential cure for several conditions that may be refractory to chemotherapy, it is associated with a host of organ toxicities, with AKI being one of the most common serious complications of HCT (14). The incidence and timing of AKI after HCT vary according to the type of transplant.…”

“…One explanation advanced for this troubling trend is that surgeons have converted from open to laparoscopic radical nephrectomies rather than from open radical nephrectomies to partial nephrectomies (12). The association between AKI and hematopoietic cell transplantation (HCT) has been studied in depth and reviewed recently (13,14). In particular, AKI in HCT recipients is a risk factor for both short-and long-term mortality, with a graded relationship between AKI severity and mortality risk.…”