Erratum: Contemporary analysis of the influence of acute kidney injury after reduced intensity conditioning haematopoietic cell transplantation on long-term survival

Abstract Abstract 3551 Background: Allogeneic hematopoietic cell transplantation (HCT) may even cure leukemia following relapse or primary induction failure. Several pre-transplant variables including age, duration of remission, poor-risk cytogenetics, tumor burden at HCT, type of donor, and performance status reportedly affected the post-HCT prognosis of leukemia that is not in remission. However, there has been insufficient examination of the factors required to achieve long-term survival or cure of leukemia that is not in remission at HCT. We might consider long-term survival without relapse, particularly for more than 5 years, as ‘likely cure' of leukemia. Therefore, we evaluated the factors that contribute to long-term survival (for more than 5 years) in patients with active leukemia at HCT. Method: We retrospectively performed an analysis of leukemia not in remission at HCT performed at our single institute between January 1999 and July 2009. Forty-two patients aged from 15 to 67 years (median age: 39 years) received intensified myeloablative (n=9), myeloablative (n=11) or reduced-intensity conditioning (n=22) for HCT. Twelve patients received individual chemotherapy for cytoreduction within the three weeks before reduced-intensity conditioning for HCT. Diagnoses included de novo AML (n=17), ALL (n=12), CML-AP (n=2), MDS/AML (n=10) and plasma cell leukemia (n=1). In those with acute leukemia, cytogenetic abnormalities were intermediate (n=17, 44%)or poor (n=22, 56%). Seven patients were primarily refractory to induction chemotherapy. The other patients relapsed after conventional chemotherapy or the first HCT. The median number of blast cells in bone marrow (BM) was 26.0% (range; 0.2–100) before the start of chemotherapy for HCT. Six patients had leukemic involvement of the central nerve system. Stem cell sources were related BM (n=3, 7%), related peripheral blood (n=13, 31%) unrelated BM (n=20, 48%) and unrelated cord blood (CB) (n=6, 14%). Thirty-one pairs were matched for HLA-A, B and DRB1 antigens. Three patients were mismatched for one HLA antigen (two at HLA-A, one at HLA-B), and seven were mismatched for two (two at HLA-A and B, five (all CB) at HLA-B and DRB1). The remaining patient was mismatched for all three antigens. Prophylaxis for acute GVHD consisted of calcineurin alone (n=5), calcineurin combined with short-term methotrexate (n=32), calcineurin combined with mycophenolate mofetil (n=2) or none (n=3). In this study, we defined long-term survival as survival without relapse for more than 5 years. Results: Engraftment was achieved in 33 (79%) of 42 patients. Median time to engraftment was 17 days (range: 9–32). Five patients died early after HCT (range 4–20 days). Twenty four (65%) of 37 evaluable patients developed acute GVHD (eight grade I, nine grade II, five grade III, two grade IV), and 12 (50%) of 24 evaluable patients developed chronic GVHD (1 limited, 11 extensive). With a median follow up of 85 months for surviving patients, the five-year Kaplan-Meier estimates of leukemia-free survival rate and overall survival (OS) were 17% and 19%, respectively. At five years, the cumulative probability of non-relapse mortality was 38%. In the univariate analyses of impact of pre-transplant variables on OS, poor-risk cytogenetics, number of BM blasts (>26%), MDS/AML and CB as stem cell source were significantly associated with worse prognosis (p=.03, p=.01, p=.02 and p<.001, respectively). In addition, the five-year Kaplan-Meier estimates of OS in patients with and without cGVHD were 66.7% and 0% (p<.001) respectively. Conclusion: Graft-versus-leukemia effects mediated by cGVHD may have played a crucial role in long-term survival in, or cure of active leukemia. We speculate that effective cytoreduction by individual chemotherapy and/or conditioning for HCT to control disease until cGVHD subsequently occurred might be also important, particularly in leukemia with rapid proliferation. However, intensive conditioning for HCT did not appear to be indispensable in relatively indolent leukemia, even with non-remission status at HCT. In addition, based on our results, CB might be unsuitable as a source of stem cells for leukemia that is active at the time of HCT. Disclosures: No relevant conflicts of interest to declare.

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The duration of postoperative acute kidney injury is an additional parameter predicting long-term survival in diabetic veterans

Kidney International ◽

10.1038/ki.2010.259 ◽

2010 ◽

Vol 78 (9) ◽

pp. 926-933 ◽

Cited By ~ 118

Author(s):

Steven G. Coca ◽

Joseph T. King ◽

Ronnie A. Rosenthal ◽

Melissa F. Perkal ◽

Chirag R. Parikh

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Additional Parameter ◽

Term Survival ◽

Long Term Survival

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1370: EPIDEMIOLOGY AND LONG-TERM SURVIVAL FOR DIFFERENT TRAJECTORIES OF ACUTE KIDNEY INJURY AFTER SEPSIS

Critical Care Medicine ◽

10.1097/01.ccm.0000529373.78984.91 ◽

2018 ◽

Vol 46 (1) ◽

pp. 668-668

Author(s):

Tezcan Ozrazgat Baslanti ◽

Zhongkai Wang ◽

Gabriella Ghita ◽

Larysa Sautina ◽

Rajesh Mohandas ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Term Survival ◽

Long Term Survival

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Renal recovery and long-term survival following acute kidney injury after coronary artery surgery: a nationwide study

Acta Anaesthesiologica Scandinavica ◽

10.1111/aas.12758 ◽

2016 ◽

Vol 60 (9) ◽

pp. 1230-1240 ◽

Cited By ~ 21

Author(s):

S. Helgadottir ◽

M. I. Sigurdsson ◽

R. Palsson ◽

D. Helgason ◽

G. H. Sigurdsson ◽

...

Keyword(s):

Acute Kidney Injury ◽

Coronary Artery ◽

Kidney Injury ◽

Renal Recovery ◽

Coronary Artery Surgery ◽

Term Survival ◽

Long Term Survival ◽

Nationwide Study

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Malnutrition screening and acute kidney injury in hospitalised patients: a retrospective study over a 5-year period from China

British Journal Of Nutrition ◽

10.1017/s000711451900271x ◽

2019 ◽

Vol 123 (3) ◽

pp. 337-346 ◽

Cited By ~ 1

Author(s):

Chenyu Li ◽

Lingyu Xu ◽

Chen Guan ◽

Long Zhao ◽

Congjuan Luo ◽

...

Keyword(s):

Acute Kidney Injury ◽

Nutritional Status ◽

Cox Regression ◽

Kidney Injury ◽

Nutritional Risk ◽

Term Survival ◽

Long Term Survival ◽

Hospitalised Patients ◽

Nrs 2002

AbstractMalnutrition and acute kidney injury (AKI) are common complications in hospitalised patients, and both increase mortality; however, the relationship between them is unknown. This is a retrospective propensity score matching study enrolling 46 549 inpatients, aimed to investigate the association between Nutritional Risk Screening 2002 (NRS-2002) and AKI and to assess the ability of NRS-2002 and AKI in predicting prognosis. In total, 37 190 (80 %) and 9359 (20 %) patients had NRS-2002 scores <3 and ≥3, respectively. Patients with NRS-2002 scores ≥3 had longer lengths of stay (12·6 (sd 7·8) v. 10·4 (sd 6·2) d, P < 0·05), higher mortality rates (9·6 v. 2·5 %, P < 0·05) and higher incidence of AKI (28 v. 16 %, P < 0·05) than patients with normal nutritional status. The NRS-2002 showed a strong association with AKI, that is, the risk of AKI changed in parallel with the score of the NRS-2002. In short- and long-term survival, patients with a lower NRS-2002 score or who did not have AKI achieved a significantly lower risk of mortality than those with a high NRS-2002 score or AKI. Univariate Cox regression analyses indicated that both the NRS-2002 and AKI were strongly related to long-term survival (AUC 0·79 and 0·71) and that the combination of the two showed better accuracy (AUC 0·80) than the individual variables. In conclusion, malnutrition can increase the risk of AKI and both AKI and malnutrition can worsen the prognosis that the undernourished patients who develop AKI yield far worse prognosis than patients with normal nutritional status.

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Faculty Opinions recommendation of Long-Term Survival in Patients With Acute Kidney Injury After Acute Type A Aortic Dissection Repair.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726480019.793520508 ◽

2016 ◽

Author(s):

John Augoustides

Keyword(s):

Acute Kidney Injury ◽

Aortic Dissection ◽

Kidney Injury ◽

Type A ◽

Acute Type ◽

Term Survival ◽

Type A Aortic Dissection ◽

Long Term Survival

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A Simple Prognostic Score to Predict Short and Long-Term Survival Following ICU Admission in Critically Ill Adult Allogeneic Hematopoietic Stem Cell Transplant Recipients: Improved Survival Following Reduced Intensity Conditioning

Blood ◽

10.1182/blood.v118.21.146.146 ◽

2011 ◽

Vol 118 (21) ◽

pp. 146-146

Author(s):

William Townsend ◽

Ailsa Holroyd ◽

Rachel M Pearce ◽

Stephen Mackinnon ◽

Anthony H. Goldstone ◽

...

Keyword(s):

Stem Cell ◽

Critically Ill ◽

Reduced Intensity Conditioning ◽

Myeloablative Conditioning ◽

Term Survival ◽

Hematopoietic Stem ◽

Long Term Survival ◽

Icu Admission ◽

Reduced Intensity

Abstract Abstract 146 Transplant-related complications necessitate intensive care unit (ICU) admission in a significant proportion of patients undergoing allogeneic hematopoietic stem cell transplantation (Allo-HSCT). Historically patients requiring ICU admission for transplant related toxicities have fared extremely poorly with very high ICU mortality rates. Although recent reports have indicated improvements in short-term survival for Allo-HSCT patients admitted to ICU there are little data on the subsequent long-term survival of ICU survivors and the impact of reduced intensity conditioning regimens in this cohort of patients. Methods: A retrospective analysis of data collected from 164 consecutive adult Allo-HSCT recipients admitted to ICU (with a total of 214 ICU admissions), at a single centre, University College London Hospitals NHS Foundation Trust (UCLH) between June 1996 and December 2007 (11.5 year study period) was performed. Follow-up of surviving patients was recorded until 31 March 2011. Results: 29% of all patients undergoing Allo-HSCT at our centre during the study period required one or more ICU admission. The ICU admission rate was significantly lower for patients undergoing reduced intensity conditioning (RIC) than myeloablative conditioning (17% vs. 38%, p<0.001). The median age of RIC-Allo recipients was significantly older than patients who received myeloablative conditioning (47 vs 36 years, P<0.0001). The most frequent reasons for ICU admission were sepsis (67%) and respiratory failure (55%), not mutually exclusive. Mechanical ventilation (MV) was required in 53% of admissions, inotropic support was required in 47%. Median acute physiology and chronic health score (APACHEII) was 23 (range 0–51). Overall ICU survival for all admissions was 48% (n=214). 35 patients (21%) had more 1 or more ICU admissions. Survival by patient (measured at discharge from final ICU admission) was 32%. ICU survival was significantly better after RIC Allo-HSCT than following myeloablative conditioning (OR 3.27, p=0.023). There was no difference in ICU outcome by stem cell source (sibling vs. unrelated). Patients who did not require ventilatory support (non-invasive ventilation and/or MV) had significantly better ICU outcome (OR 12.7, p<0.001). Multivariate analysis by Cox regression revealed raised urea, inotropic support and MV as independent determinants of death on ICU. Long term survival was significantly better for patients who underwent RIC Allo-HSCT (p=0.0055) (Figure 1). The subsequent long term survival for patients who survived ICU admission was excellent; 1, 2, and 5 year survival rates were 60%, 55%, and 50% respectively (median follow-up 3 years, 7 months).A simple prognostic scoring system has been derived which is predictive of both ICU survival and long term outcome (Table 1). Patients with 2 or more of the following factors: myeloablative conditioning, MV, elevated serum urea, score 1. Patients with <2 of these factors score 0. In our patient population, this binary index has been shown to be predictive of both death on ICU (OR 7.24, p=0.001) or poorer overall survival after ICU discharge (OR 3.04, p=0.01). Conclusion: In this study we report favourable ICU survival following allogeneic HSCT and for the first time report significantly better short and long-term outcome for patients who underwent RIC Allo-HSCT compared to those treated with myeolablative conditioning regimens despite a higher median age in the patients undergoing RIC transplants. For patients surviving ICU admission, subsequent long-term overall survival was excellent at 50% at 5 years, comparing favourably with other critically ill non-surgical patients admitted to ICU. A simple prognostic score has been generated which can be used to predict outcome in critically ill patients admitted to ICU following Allo-HSCT. Disclosures: No relevant conflicts of interest to declare.

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