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Transplant Toxicities

Early-onset acute kidney injury is a poor prognostic sign for allogeneic SCT recipients

Bone Marrow Transplantation volume 50, pages 1557–1562 (2015)Cite this article

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Abstract

Acute kidney injury (AKI) following stem-cell transplantation (SCT) contributes to a poor prognosis, yet its impact may vary depending on the timing of AKI onset. A prospective cohort study was performed to understand the significance of the onset timing in 103 allogeneic SCT (allo-SCT) recipients. AKI prior to stem-cell engraftment was defined as early AKI and subsequently occurring AKI as late AKI. Propensity score (PS) for early AKI was calculated using a logistic regression model to reduce confounding effects related to differences in clinical background between the early and late AKI groups. The cumulative incidences of early and late AKI were 22.3% and 54.9%, respectively. Non-relapse mortality (NRM) was 39.1% and 7.0%, and overall survival (OS) was 56.5% and 90.9% in early and late AKI at 100 days after AKI, respectively (P<0.001). The cumulative incidence of chronic kidney disease (CKD) over 2 years after SCT was 41.5% and 19.1% in early and late AKI, respectively (P=0.048). Logistic regression analysis adjusted for the PS showed that early AKI was significantly associated with OS (odds ratio (95% confidence interval); 4.63 (1.15–21.4), P=0.031) but with neither NRM (1.25 (0.28–5.33), P=0.766) nor CKD (1.85 (0.41–8.60), P=0.422). In conclusion, early AKI may portend a poor survival for allo-SCT recipients.

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Acknowledgements

We thank Makoto Saito, MSc, who helped with the statistical analysis.

Author contributions

MA designed the study and wrote the manuscript and was responsible for the study. NS and TM collected and analyzed the data and wrote the manuscript. YN, TK, ND, KK and KO contributed to the collection of raw data from SCT patients.

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, Tokyo Metropolitan Cancer Center, Komagome Hospital, Tokyo, Japan

    N Shingai, Y Najima, T Kobayashi, N Doki, K Kakihana & K Ohashi

  2. Division of Nephrology, Department of Medicine, Tokyo Metropolitan Cancer Center, Komagome Hospital, Tokyo, Japan

    T Morito & M Ando

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  1. N Shingai
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  2. T Morito
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  3. Y Najima
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  7. K Ohashi
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Correspondence to M Ando.

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Shingai, N., Morito, T., Najima, Y. et al. Early-onset acute kidney injury is a poor prognostic sign for allogeneic SCT recipients. Bone Marrow Transplant 50, 1557–1562 (2015). https://doi.org/10.1038/bmt.2015.188

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