Kidney Transplantation After Allogeneic Hematopoietic Cell Transplantation

• Published in: Kidney international reports Vol. 9; no. 4; pp. 1127 - 1131
• Main Authors: Ziliotis, Marie-Julia, Vauchy, Charline, Deconinck, Eric, Berceanu, Ana, Büchler, Mathias, Caillard, Sophie, Couzi, Lionel, Dussol, Bertrand, Frimat, Luc, Hazzan, Marc, Jaulin, Jean-Paul, Malvezzi, Paolo, Peffault de Latour, Régis, Ducloux, Didier, Courivaud, Cécile
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2024; Elsevier
• Series: Kidney International Reports
• Subjects: allogenic; deceased donor; hematopoietic stem cell transplantation; kidney transplantation; Life Sciences; Research Letter; hematopoietic stem cell transplantation; deceased donor; allogenic; kidney transplantation
• ISSN: 2468-0249; 2468-0249
• DOI: 10.1016/j.ekir.2024.01.048

IntroductionHematopoietic stem cell transplantation (HSCT) aims to cure multiple hematologic malignancies, nonmalignant diseases, metabolic disorders, and immune deficiencies. Along with other transplant-related organ toxicities, both acute and chronic kidney disease are common complications of allogeneic HSCT, affecting 10% to 73% and 0% to 60% of patients respectively, depending on the definitions of kidney dysfunction, duration of follow-up and transplant strategies.S1–S4 The proportion of patients with chronic kidney disease who develop end-stage renal disease is approximately 4%. Among those patients who progress to end-stage renal disease and require hemodialysis, mortality is approximately 90%. Few studies have reported successful kidney transplantation (KT) after HSCT in adults; these were mostly small single-center cohorts often with the same donor for HSCT and kidney, and short follow-up.1,2To investigate mortality and the occurrence of severe infections and cancers, we conducted a French multicenter retrospective study of patients who underwent KT, after previous allogeneic HSCT. The details of study methods are shown in the Supplementary Methods.ResultsNineteen KT patients with a history of HSCT were identified, of whom 3 had received a kidney from the HSCT donor: the remaining 16 patients were included in the analysis (Table 1 and Supplementary Table S1). Patients were allografted between 1986 and 2006, including 12 patients before 2000, at a median age of 31 (9–55) years (3 pediatric patients and 1 patient older than 45 years). The main indication for HSCT was acute leukemia (n = 11/16: 8 acute myeloid leukemia and 3 acute lymphoblastic leukemia). Three patients had undergone 2 consecutive HSCT (2 relapses and 1 autologous HSCT before allogeneic HSCT). Myeloablative conditioning (n = 14/16) was performed and the graft came from a matched related donor (n = 12/16) in the majority of cases. Baseline nephrologic status was partially or fully available for 9 patients. At the time of HSCT, the 2 most recently allografted patients, the only ones to receive nonmyeloablative conditioning regimen, were already on hemodialysis. Two patients were with stage 2 chronic kidney disease and 5 had no kidney failure.