Long-term renal outcome after allogeneic hemopoietic stem cell transplant: A comprehensive analysis of risk factors in an Asian patient population

Clin Transplant. 2017 Apr;31(4). doi: 10.1111/ctr.12920. Epub 2017 Mar 1.

Abstract

Allogeneic hemopoietic stem cell transplantation (allo-HSCT) poses a significant challenge to renal function due to multiple drug- and complication-related renal toxicity. In this single-center series of 216 adult Asian patients with a long and complete follow-up, 41 developed chronic kidney disease (CKD) giving a cumulative incidence of 19.0% at 25 years (median follow-up duration 7.84 years, range 2.0-27.7 years), but only two of the 41 patients reached stage 4 CKD and another two required dialysis. In contrast, acute kidney injury occurred in most patients, where glomerular filtration rate (GFR) suffered a mean fall of 50 mL/min/1.73 m2 at 6 months post-transplant compared with baseline. Suppression of renal function may last beyond 6 months but is potentially reversible, although not to baseline level in most patients. Analysis of a comprehensive range of 18 risk factors showed that older age, lower GFR at transplant, unrelated donor, diagnosis of AML, presence of diabetes mellitus at transplant, and duration of foscarnet use were significantly associated with CKD development, with the first three remaining as independent risks for CKD in multivariate analysis. Long-term survival is not affected by renal function, being 78.6% as compared to 85.5% for patients with low vs normal GFR at 2 years, respectively.

Keywords: acute kidney injury; allogeneic hemopoietic stem cell transplant; chronic kidney disease; glomerular filtration rate; long-term survival.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Graft Rejection / epidemiology
  • Graft Rejection / etiology*
  • Graft Survival
  • Graft vs Host Disease / epidemiology
  • Graft vs Host Disease / etiology*
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Incidence
  • Kidney Function Tests
  • Male
  • Middle Aged
  • Postoperative Complications*
  • Prognosis
  • Renal Insufficiency, Chronic / epidemiology
  • Renal Insufficiency, Chronic / etiology*
  • Retrospective Studies
  • Risk Factors
  • Singapore / epidemiology
  • Transplantation, Homologous
  • Young Adult