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Post-Transplant Events

Early renal injury after myeloablative allogeneic and autologous hematopoietic cell transplantation

Abstract

Renal insufficiency is a common complication early after hematopoietic stem cell transplantation (HSCT). Renal function as measured by creatinine clearance (CrCl) was prospectively evaluated in 47 patients undergoing allogeneic (n=22) or autologous (n=25) HSCT during the first 100 days. Renal dysfunction was classified as follows: Grade 0 (<25% decline in CrCl), Grade 1 (25% decline in CrCl but <2 × increase in serum creatinine), Grade 2 (2 × rise in serum creatinine but no need for dialysis) and Grade 3 (2 × rise in serum creatinine and need for dialysis). Thirty-three patients (70%) had Grade 1–3 renal dysfunction. Renal dysfunction was more common after myeloablative allogeneic HSCT (91%) than autologous HSCT (52%) (P=0.004), and was associated with a high risk of mortality (P=0.039). Sepsis in autologous HSCT patients and cyclosporine toxicity in allogeneic HSCT patients were associated with renal dysfunction. We conclude that autologous and allogeneic HSCT differ in the likelihood and causes of renal dysfunction.

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References

  1. Gratwohl A, Baldomero H, Passweg J, Frassoni F, Niederwieser D, Schmitz N et al. Accreditation Committee of the European Group for Blood and Marrow Transplantation (EBMT) in cooperation with the Working Parties Acute (ALWP) and Chronic Leukemias (CLWP) and the Lymphoma Working Party. Hematologic stem cell transplantation for hematological malignancies in Europe. Leukemia 2003; 17: 941–959.

    Article  CAS  Google Scholar 

  2. Thomas ED . Bone marrow transplantation – past, present and future. The Nobel prizes, 1990. The Nobel Foundation: Stockholm, Sweden, 1990.

  3. Zager RA, O'Quigley J, Zager BK, Alpers CE, Shulman HM, Gamelin LM . et al. Acute renal failure following bone marrow transplantation: a retrospective study of 272 patients. Am J Kidney Dis 1989; 13: 210–216.

    Article  CAS  Google Scholar 

  4. Zager RA . Acute renal failure in the setting of bone marrow transplantation. Kidney Int 1994; 46: 1443–1458.

    Article  CAS  Google Scholar 

  5. Gruss E, Bernis C, Tomas JF, Garcia-Canton C, Figuera A, Motellon JL et al. Acute renal failure in patients following bone marrow transplantation: prevalence, risk factors and outcome. Am J Nephrol 1995; 15: 473–479.

    Article  CAS  Google Scholar 

  6. Herget-Rosenthal S, Uppenkamp M, Beelen D, Kohl D, Kribben A . Renal complications of high-dose chemotherapy and peripheral blood stem cell transplantation. Nephron 2000; 84: 136–141.

    Article  CAS  Google Scholar 

  7. El Seisi S, Gupta R, Clase CM, Forrest DL, Milandinovic M, Couban S . Renal pathology at autopsy in patients who died after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2003; 9: 683–688.

    Article  Google Scholar 

  8. Smith DM, Weisenburger DD, Bierman P, Kessinger A, Vaughan WP, Armitage JO . Acute renal failure associated with autologous bone marrow transplantation. Bone Marrow Transplant 1987; 2: 195–201.

    CAS  Google Scholar 

  9. McDonald GB, Hinds MS, Fisher LD, Schoch HG, Wolford JL, Banaji M et al. Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: a cohort study of 355 patients. Ann Intern Med 1993; 118: 255–267.

    Article  CAS  Google Scholar 

  10. Jones RJ, Lee KS, Beschorner WE, Vogel VG, Grochow LB, Braine HG et al. Venocclusive disease of the liver following bone marrow transplantation. Transplantation 1987; 44: 778–783.

    Article  CAS  Google Scholar 

  11. Shulman H, Striker G, Deeg HJ, Kennedy M, Storb R, Thomas ED . Nephrotoxicity of cyclosporine A after allogeneic marrow transplantation. Glomerular thromboses and tubular injury. N Engl J Med 1981; 305: 1392–1395.

    Article  CAS  Google Scholar 

  12. Rabinowe SN, Soiffer RJ, Tarbell NJ, Neuberg D, Freedman AS, Seifter J et al. Hemolytic-uremic syndrome following bone marrow transplantation in adults for hematologic malignancies. Blood 1991; 77: 1837–1844.

    CAS  Google Scholar 

  13. Cockcroft SW, Gault HM . Prediction of creatinine clearances from serum creatinine. Nephron 1976; 16: 31–41.

    Article  CAS  Google Scholar 

  14. Merouani A, Shpall EJ, Jones RB, Archer PG, Schrier RW . Renal function in high dose chemotherapy and autologous hematopoietic cell support treatment for breast cancer. Kidney Int 1996; 50: 1026–1031.

    Article  CAS  Google Scholar 

  15. Parikh CR, McSweeney PA, Korular D, Ecder T, Merouani A, Taylor J et al. Renal dysfunction in allogeneic hematopoietic cell transplantation. Kidney Int 2002; 62: 566–573.

    Article  Google Scholar 

  16. Kone BC, Whelton A, Santos G, Saral R, Watson AJ . Hypertension and renal dysfunction in bone marrow transplant recipients. Q J Med 1988; 260: 985–995.

    Google Scholar 

  17. Cohen EP . Renal failure after bone-marrow transplantation. Lancet 2001; 357: 6–7.

    Article  CAS  Google Scholar 

  18. Noel C, Hazzan M, Noel-Walter MP, Jouet JP . Renal failure and bone marrow transplantation. Nephrol Dial Transplant 1998; 13: 2464–2466.

    Article  CAS  Google Scholar 

  19. Atkinson K, Downs K, Ashby M, Biggs J . Clinical correlations with cyclosporine blood levels after allogeneic bone marrow transplantation: an analysis of four different assays. Transplant Proc 1990; 22: 1331–1334.

    CAS  Google Scholar 

  20. Yee GC, Self SG, McGuire TR, Carlin J, Sanders JE, Deeg HJ . Serum cyclosporine concentrations and risk of acute graft-versus-host disease after allogeneic marrow transplantation. N Eng J Med 1988; 319: 65–70.

    Article  CAS  Google Scholar 

  21. Parikh CR, Sandmaier BM, Storb RF, Blume KG, Sahebi F, Maloney DG et al. Acute renal failure after nonmyeloablative hematopoietic cell transplantation. J Am Soc Nephrol 2004; 15: 1868–1876.

    Article  Google Scholar 

  22. Cooper BW, Creger RJ, Soegiarso W, Mackay WL, Lazarus HM . Renal dysfunction during high-dose cisplatin therapy and autologous hematopoietic stem cell transplantation: effect of aminoglycoside therapy. Am J Med 1993; 94: 497–504.

    Article  CAS  Google Scholar 

  23. Zager RA . Gentamicin nephrotoxicity in the setting of acute renal hypoperfusion. Am J Physiol 1988; 254: F574–F581.

    CAS  PubMed  Google Scholar 

  24. Zager RA, Prior RB . Gentamicin and gram-negative bacteremia. A synergism for the development of experimental nephrotoxic acute renal faiure. J Clin Invest 1986; 78: 196.

    Article  CAS  Google Scholar 

  25. Baylis C, Ichikawa I, Willis WT, Wilson CB, Brenner BM . Dynamics of glomerular ultrafilration. IX. Effects of plasma protein concentration. Am J Physiol 1977; 232: F58–F71.

    CAS  PubMed  Google Scholar 

  26. Contreras AM, Ramirez M, Cueva L, Alvarez S, de Loza R, Gamba G . Low serum albumin and the increased risk of amikacin nephrotoxicity. Rev Intest Clin 1994; 46: 37–43.

    CAS  Google Scholar 

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Correspondence to Y Caliskan.

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Caliskan, Y., Besisik, S., Sargin, D. et al. Early renal injury after myeloablative allogeneic and autologous hematopoietic cell transplantation. Bone Marrow Transplant 38, 141–147 (2006). https://doi.org/10.1038/sj.bmt.1705412

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