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

• Published in: Bone marrow transplantation (Basingstoke) Vol. 42; no. 9; pp. 619 - 626
• Main Authors: Lopes, J A, Gonçalves, S, Jorge, S, Raimundo, M, Resende, L, Lourenço, F, Lacerda, J F, Martins, C, do Carmo, J A, Lacerda, J M F, Prata, M M
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.11.2008; Nature Publishing Group
• Subjects: Acute Disease; Adolescent; Adult; Analysis; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Cardiovascular diseases; Cell Biology; Complications and side effects; Conditioning; Disease-Free Survival; End-stage renal disease; Failure; Female; Graft-versus-host reaction; Health risks; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic stem cells; Humans; Injury analysis; Injury prevention; Internal Medicine; Kidney diseases; Kidney Diseases - etiology; Kidney Failure, Chronic - etiology; Kidneys; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Mortality; Nephrology. Urinary tract diseases; original-article; Patient outcomes; Public Health; Renal failure; Retrospective Studies; Risk; Stem cell transplantation; Stem Cells; Survival; Survival analysis; Survival Rate; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning - methods; Transplants & implants; Urinary system involvement in other diseases. Miscellaneous; Young Adult; acute kidney injury; haematopoietic cell transplantation; long-term survival; reduced intensity conditioning; Kidney disease; Urinary system disease; Hematology; Acute kidney injury; Hematopoietic cell; Graft; Non myeloablative treatment; Long term; Survival
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2008.207

We evaluated retrospectively the incidence of acute kidney injury (AKI), defined by risk, injury, failure, loss and end-stage kidney disease (RIFLE) and its influence on long-term survival, in 82 patients aged 18–60 years who underwent a reduced intensity conditioning (RIC) haematopoietic cell transplantation (HCT). Patients (53.6%) developed AKI after HCT: 25% were on risk, 45.5% on injury and 29.5% on failure. In all, 64 patients survived after 100 days of post transplant and were available for long-term survival analysis. At follow-up, 43.7% of patients died. A 5-year overall survival of AKI patients was 41.6% as compared with 67.1% for those who did not develop AKI ( P =0.028), and decreased according to AKI severity (risk, 55.6%; injury plus failure, 33.3%; P =0.045). After adjusting for age, history of cardiovascular disease, high-risk disease and chronic GVHD, AKI predicted 5-year overall mortality (AKI: adjusted hazards ratio (AHR), 2.36, 95% CI: 1.03–5.37; P =0.041). Moreover, moderate and severe AKI (injury plus failure) was also associated with an increased 5-year overall mortality (injury plus failure: AHR, 1.64, 95% CI: 1.06–2.54; P =0.024). According to RIFLE, 53.6% of patients had AKI after RIC HCT. Such patients have poor long-term survival, particularly in moderate or severe AKI.