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Acute kidney injury in critically ill allo-HSCT recipients

Bone Marrow Transplantation volume 49, pages 1121–1122 (2014)Cite this article

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We read with great interest the study by Benz et al.1 on risk factors and outcomes of patients admitted to the intensive care unit (ICU) after allogeneic hematopoietic SCT (allo-HSCT). They found that acute GVHD and HLA mismatch were associated with ICU admission. They also reported poor outcomes after ICU admission (case fatality rate 64%), mostly related to the extent of organ dysfunction. On the basis of our experience,2 we would like to draw attention to the clinical relevance of acute kidney injury (AKI) in allo-HSCT recipients, a feature not addressed by Benz et al. Indeed, allo-HSCT recipients are known to be at high risk for AKI as they often are exposed to combinations of various nonspecific insults (sepsis, nephrotoxic drugs, contrast agents, dehydration, kidney infiltration by the malignancy, anemia). In addition, they can develop specific causes of AKI over time such as tumor lysis syndrome, engraftment syndrome, veno-occlusive disease (VOD) and thrombotic microangiopathy (TMA).3

In our center, of 647 allo-HSCT performed over five years (January 2007 to December 2011), we report on 75 patients (11.6%) who were admitted to the ICU. Time between HSCT and ICU admission was 149 (interquartile range (IQR), 29–594) days. The median age was 43 (IQR, 28–57) years and 53 (70%) were male. The main indications for allo-HSCT were ALL (20, 26.6%), AML (14, 18.6%) and lymphoma (12, 16%). The transplant procedure was performed mostly with a reduced-intensity regimen (44, 59%), graft source was PBSC (52, 71%) and the donor was unrelated (30, 41%) or a matched sibling (28, 37%).

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References

  1. Benz R, Schanz U, Maggiorini M, Seebach JD, Stussi G . Risk factors for ICU admission and ICU survival after allogeneic hematopoietic SCT. Bone Marrow Transplant 2014; 49: 62–65.

    Article  CAS  Google Scholar 

  2. Azoulay E, Mokart D, Pène F, Lambert J, Kouatchet A, Mayaux J et al. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium—a groupe de recherche respiratoire en réanimation onco-hématologique study. J Clin Oncol 2013; 31: 2810–2818.

    Article  Google Scholar 

  3. Kogon A, Hingorani S . Acute kidney injury in hematopoietic cell transplantation. Semin Nephrol 2010; 30: 615–626.

    Article  Google Scholar 

  4. Kellum JA, Lameire N, for the KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary. Crit Care 2013; 17((Part 1)): 204.

    Article  Google Scholar 

  5. Gooley TA, Chien JW, Pergam SA, Hingorani S, Sorror ML, Boeckh M et al. Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med 2010; 363: 2091–2101.

    Article  CAS  Google Scholar 

  6. Pène F, Aubron C, Azoulay E, Blot F, Thiéry G, Raynard B et al. Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients: a reappraisal of indications for organ failure supports. J Clin Oncol 2006; 24: 643–649.

    Article  Google Scholar 

  7. Moreau AS, Seguin A, Lemiale V, Yakoub-Agha I, Girardie P, Robriquet L et al. Survival and prognostic factors of allogeneic hematopoietic stem cell transplant recipients admitted to intensive care unit. Leuk Lymphoma (e-pub ahead of print 13 September 2013

    Article  Google Scholar 

  8. Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW . Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005; 16: 3365–3370.

    Article  Google Scholar 

  9. Wald R, Quinn RR, Luo J, Li P, Scales DC, Mamdani MM et al. Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA 2009; 302: 1179–1185.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Medical Intensive Care Unit, Saint-Louis University Hospital, Paris, France

    E Canet, L Zafrani & E Azoulay

  2. Hematology Department, Saint-Louis University Hospital, Paris, France

    E Lengline & G Socié

  3. Nephrology Department, Saint-Louis University Hospital, Paris, France

    M-N Peraldi

  4. Université Paris-Diderot, Sorbonne Paris-Cité, School of Medicine, Paris, France

    M-N Peraldi, G Socié & E Azoulay

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  1. E Canet
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  2. E Lengline
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Correspondence to E Canet.

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Canet, E., Lengline, E., Zafrani, L. et al. Acute kidney injury in critically ill allo-HSCT recipients. Bone Marrow Transplant 49, 1121–1122 (2014). https://doi.org/10.1038/bmt.2014.100

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