Acute Kidney Injury in Pediatric Patients Receiving Allogeneic Hematopoietic Cell Transplantation: Incidence, Risk Factors, and Outcomes

Abstract

Acute kidney injury (AKI) is a common adverse event after hematopoietic cell transplantation (HCT). AKI is associated with early death or chronic kidney disease among transplant survivors. However, large-scale pediatric studies based on standardized criteria are lacking. We performed a retrospective analysis of 1057 pediatric patients who received allogeneic HCT to evaluate the incidence and risk factors of AKI according to AKI Network criteria within the first 100 days of HCT. We also determined the effect of AKI on patient survival. The 100-day cumulative incidences of all stages of AKI, stage 3 AKI, and AKI requiring renal replacement therapy (RRT) were 68.2% ± 1.4%, 25.0% ± 1.3%, and 7.6% ± .8%, respectively. Overall survival at 1 year was not different between patients without AKI and those with stage 1 or 2 AKI (66.1% versus 73.4% versus 63.9%, respectively) but was significantly different between patients without AKI and patients with stage 3 AKI with or without RRT requirement (66.1% versus 47.3% versus 7.5%, respectively; P < .001). Age, year of transplantation, donor type, sinusoidal obstruction syndrome (SOS), and acute graft-versus-host disease (GVHD) were independent risk factors for stages 1 through 3 AKI. Age, donor, conditioning regimen, number of HCTs, SOS, and acute GVHD were independent risk factors for AKI requiring RRT. Our study revealed that AKI was a prevalent adverse event, and severe stage 3 AKI, which was associated with reduced survival, was common after pediatric allogeneic HCT. All patients receiving allogeneic HCT, especially those with multiple risk factors, require careful renal monitoring according to standardized criteria to minimize nephrotoxic insults.

Stable renal function in children and adolescents with sickle cell disease after nonmyeloablative hematopoietic stem cell transplantation

“…[52][53] During their admission following HSCT, the kidney function of our cohort remained stable with no episodes of AKI or FO. This is remarkable considering the high burden of AKI (54.6%) recently reported by Koh et al 29 in children with hematological malignancies post-HSCT and the higher general risk of AKI in SCD patients with sickling crises. 7,[54][55][56] The omission of nephrotoxic chemotherapy and medications including calcineurin inhibitors in the NMA-HSCT regimen and less infectious complications such as sepsis may help protect from AKI as compared with HSCT for malignant indications.…”

“…7,[27][28] AKI and fluid overload (FO) are common events in pediatric HSCT with reported AKI incidence of 21%-68.2%. [29][30][31][32] Moreover, one well-known side effect of calcineurin inhibitors-hypertension-is also a risk factor for progressive CKD. 33 Patients who experience renal complications from…”

“…HSCT have a higher mortality, and AKI is associated with higher longterm morbidity and mortality post-HSCT. 11,[28][29]31,[34][35] The multiple complications associated with MAC might delay curative interventions in young SCD patients, in whom the best HSCT outcomes have been reported. 24 Several reduced intensity conditioning/nonmyeloablative conditioning (NMA) regimens show promising results in SCD.…”

Markers of acute kidney injury in children undergoing hematopoietic stem cell transplantation

“…Among them, acute kidney injury (AKI) has become one of the major challenges, as it is an independent predictive factor for patient survival and progression to chronic kidney disease (CKD). 1,2 Although there are many reviews on HSCT, few of them concern the pediatric population, [3][4][5] and none of them concentrate on the nephrological aspects of HSCT.…”

Pediatric Classification and Epidemiology of Acute Renal Injury

“…Результаты исследований в педиатрической нефрологии демонстрируют эволюцию эпидемиологии острого повреждения почек от собственно первичного почечного заболевания к вторичному причинно-значимому заболеванию и/или его лечению [14][15][16][17][18][19][20]. В литературе представлена частота развития у новорожденных, детей и подростков кардиохирургически-ассоциированного острого повреждения почек [22][23][24][25][26][27][28][29][30][31][32] и острого повреждения почек после трансплантации гемопоэтических стволовых клеток [33][34][35][36][37]. Данные центров подтверждают развитие острого повреждения почек в 15-64% случаев у детей с врожденными пороками сердца после кардиохирургических вмешательств (табл.…”