Renal dysfunction in allogeneic hematopoietic cell transplantation

Abstract

A 92% incidence of renal dysfunction in allogeneic HCT patients was found. Lung and liver toxicities were significantly correlated with developing renal dysfunction, and the mortality rates for patients with Grade 3 renal failure exceeded 80%.

Acute renal failure after allogeneic myeloablative stem cell transplantation: retrospective analysis of incidence, risk factors and survival

“…This is longer than reported in other studies. 9,10,24 The one complication that was associated with a significantly shorter time to occurrence of ARF after SCT was SOS. In patients suffering from SOS, ARF developed within a median of 19 days after SCT.…”

Acute kidney injury in HCT: an update

“…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.…”

“…Several studies have recently recognized and documented a stepwise increase in hazard of short-and long-term mortality in patients developing AKI after myeloablative and non-myeloablative HCT and, in patients requiring dialysis, mortality approached 100%. 11,13,25,26,32,33,61,79,80,83,104,105 Moreover, many of these studies have also established an increased association of numerous organ toxicities, primarily hepatic and pulmonary, as well as sepsis with AKI following either conditioning regimen. 13,54,61,80,83 CONCLUSIONS In summary, AKI occurs commonly both in myeloablative and in non-myeloablative HCT, and is associated with poor outcome.…”

Replacement of calcineurin inhibitors with daclizumab in patients with transplantation-associated microangiopathy or renal insufficiency associated with graft-versus-host disease

“…2 As calcineurin inhibitors are part of the pathogenesis of TAM and are associated with RI, withdrawal may be desirable. [30][31][32] However, calcineurin inhibitors are a central part of GVHD prophylaxis and treatment and the latter is associated with TAM. Therefore, the positive effect of withdrawal of the calcineurin inhibitor is potentially offset by the subsequent progression of GVHD.…”

“…[30][31][32][33] Furthermore, the high drug levels of calcineurin inhibitors used for long-term immunosuppression in the presence of chronic GVHD frequently cause impairment of renal function, which may lead to subsequent RI. 30,32,34 Therefore, withdrawal of the calcineurin inhibitor requires institution of an alternative immunosuppressive drug, which should not be associated with endothelial or renal toxicity. Daclizumab is a humanized antibody against the Tac subunit of the interleukin (IL)-2 receptor and has been successfully used in treatment of acute GVHD after alloHSCT as well as in RI after renal or liver transplantation.…”