Kidney Complications Due to Hematopoietic Stem Cell Transplantation-A Disorder of an Increasing Incidence?

AbstractHematopoietic stem cell transplantation (HSCT) is becoming an increasingly popular treatment considering that it is the only curative option for many malignant and non-malignant diseases. Many patients treated in this way have been followed for two or three decades post-transplant and are presumed to be cured. But, on the other hand, a great proportion of these patients are experiencing long-term side effects after HSCT, including non-malignant organ or tissue dysfunction, changes in quality of life, infections and secondary malignancy. Renal complications caused by HSCT are high and are associated with the development of both acute and chronic kidney failure. So, considering the increasing numbers of HSCT survivors many years after the transplantation, chronic kidney disease due to HSCT is becoming a growing problem and represents a new population of patients who are presented to nephrologists. The three most common forms of chronic kidney disease related to HSCT are: chronic calcineurin nephrotoxicity, glomerular disease after HSCT and HSCT associated thrombotic microangiopathy.

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MO452CHRONIC KIDNEY DISEASE TEN YEARS AFTER PEDIATRIC ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab090.0014 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Dorine Bresters ◽

Els Jol-van der Zijde ◽

Eiske Dorresteijn ◽

Marloes Louwerens ◽

Carlijn Jordans ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Stem Cell ◽

Kidney Disease ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Hematopoietic Stem Cell ◽

Hematopoietic Stem

Abstract Background and Aims Chronic kidney disease (CKD) is an important sequela of hematopoietic stem cell transplantation (HSCT), but data regarding CKD after pediatric HSCT are limited. Method In this single center cohort study, we evaluated eGFR dynamics, proteinuria and hypertension in the first decade after HSCT and assessed risk factors for chronic kidney disease in 216 pediatric long term HSCT survivors, transplanted between 2002 and 2012. Results The eGFR decreased from median 148 to 116 ml/min/1.73m2 between pre-HSCT and ten years after HSCT. CKD, defined as an eGFR <90 ml/min/1.73m2 and/or proteinuria (KDIGO stage ≥G2 or ≥A2) occurred in 21% of patients. In multivariate analysis, hematological malignancy as HSCT indication (HR 5.5, 95% CI 1.2-25) and cytomegalovirus reactivation (HR 2.4, 95% CI 1.1-5.4) were independent risk factors for CKD. One third of patients with CKD had both an eGFR <90 ml/min/1.73m2 as well as proteinuria, one third had isolated eGFR reduction and one third only had proteinuria. Hypertension was observed in 27% of patients with CKD compared to 4.4% of patients without CKD. Tubular proteinuria was present in 7% of the subgroup of patients (n=71) in which β2-microglobulinuria was measured. Conclusion In conclusion, a significant proportion of pediatric HSCT recipients developed chronic kidney disease within ten years after HSCT. Our data stress the importance of structural long term monitoring of eGFR, urine and blood pressure after HSCT to identify patients with beginning CKD who could benefit most from nephroprotective interventions.

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