Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Acute renal failure following myeloablative autologous and allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 38, page 707 (2006)Cite this article

The incidence of acute renal failure (ARF) in the early period of myeloablative hematopoietic cell transplantation (HCT) varies from 30 to 90%, and is higher in patients receiving an allogeneic HCT.1, 2, 3, 4, 5 We sought to evaluate retrospectively the incidence of ARF, defined as a doubling of serum creatinine within the first 100 days after HCT, risk factors, therapy as well as outcome of HCT patients who received a myeloablative autologous or allogeneic HCT in our hospital between January 2003 and December 2004. One hundred and forty patients (86 men, mean age: 32.9±14.69 years) were studied: 90 patients had an allogeneic HCT and 50 patients had an autologous HCT; 82 patients received a peripheral blood stem cell (PBSC) transplantation and 58 patients received a bone marrow (BM) graft. In allogeneic HCT patients, the conditioning regimen consisted of busulfan/cyclophosphamide or busulfan/cyclophosphamide combined with etoposide or melphalan in patients with advanced disease, whereas in autologous HCT patients the conditioning regimen consisted of BCNU/etoposide/cytosine-arabinoside/melphalan for lymphomas, melphalan for multiple myeloma and etoposide/melphalan/carboplatin for solid tumors. All patients received prostaglandin E1 0.5 mg/day by continuous infusion as prophylaxis for hepatic veno-occlusive disease. Patients did not differ in terms of age, sex and comorbidity, namely cardiovascular disease, diabetes mellitus or prior chronic kidney disease. The incidence of ARF was 21.5%, but did not reach a statistically significant difference between patients receiving an allogeneic or autologous HCT (27 vs 12%, P=0.07) or transplanted with BM graft or PBSC (10 vs 17%, P=NS). Nephrotoxicity (n=20), septic shock (n=16), graft-vs-host disease (n=6) and hepatic veno-occlusive disease (n=3) were the most common associated etiologies. The incidence of dialysis-dependent ARF was 30%, and was higher in patients with a BM graft (50 vs 7%, P<0.03) and more frequent in allogeneic HCT, although not statistically different (33 vs 16%, P=0.08); nine patients received renal replacement therapy: four patients were treated with intermittent hemodialysis and five patients with continuous veno-venous hemodiafiltration. Overall mortality rate was 16.4%, and was higher in patients with ARF (57 vs 6%, P=0.0001), particularly if there was a need of renal replacement therapy (100 vs 38%, P=0.006).

We demonstrate that ARF is prevalent during the early period of HCT and increases mortality, particularly if dialysis-dependent. However, in our cohort overall incidence of ARF was lower than the previously described,1, 2, 3, 4, 5 and low occurrence of veno-occlusive disease, probably related to adequate prophylactic measures, could be implied.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. 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 

  2. 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 

  3. Parikh CR, Schrier RW, Storer B, Diaconescu R, Sorror ML, Maris MB et al. Comparison of ARF after myeloablative and non-myeloablative hematopoietic cell transplantation. Am J Kidney Dis 2005; 45: 502–509.

    Article  Google Scholar 

  4. Parikh CR, McSweeney P, Schrier RW . Acute renal failure independently predicts mortality after myeloablative allogeneic and hematopoietic cell transplantation. Kidney Int 2005; 67: 1999–2005.

    Article  Google Scholar 

  5. Caliskan Y, Besisik SK, Sargin D, Ecder T . Early renal injury after myeloablative allogeneic and autologous hematopoietic cell transplantation. Bone Marrow Transplant 2006; 38: 141–147.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology and Renal Transplantation, Hospital de Santa Maria, Lisboa, Portugal

    J A Lopes, S Jorge, S Silva, E de Almeida, F Abreu & M M Prata

  2. Department of Hematology, Hospital de Santa Maria, Lisboa, Portugal

    C Martins, J A do Carmo & J F Lacerda

Authors
  1. J A Lopes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S Jorge
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E de Almeida
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F Abreu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C Martins
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J A do Carmo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J F Lacerda
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M M Prata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J A Lopes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lopes, J., Jorge, S., Silva, S. et al. Acute renal failure following myeloablative autologous and allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 38, 707 (2006). https://doi.org/10.1038/sj.bmt.1705513

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1705513

This article is cited by

Search

Advanced search

Quick links