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.

  • Original Article
  • Published:

Post-Transplant Events

A multicenter, retrospective study of acute kidney injury in adult patients with nonmyeloablative hematopoietic SCT

Abstract

Acute kidney injury (AKI) is a common early complication in patients with hematopoietic SCT (HSCT). However, there are limited data about the incidence and risk factors of AKI in patients with nonmyeloablative HSCT. We conducted a multicenter, retrospective cohort study of 62 patients from three institutions who were treated with similar protocols for nonmyeloablative HSCT. AKI was classified according to the Acute Kidney Injury Network criteria. It was shown that 29% of the patients developed AKI in the first 100 days after nonmyeloablative HSCT. The risk factor at baseline for AKI was incomplete HLA-matched transplant (odds ratio (OR) 3.6; 95% confidence interval (CI) 1.1–13.0). Complications such as acute GVHD, veno-occlusive disease of liver and sepsis were also associated with the development of AKI (OR 12.1; 95% CI 2.4–62.4). AKI was significantly associated with mortality (OR=4.7; 95% CI 1.9–11.5). We concluded that AKI is a very common complication in patients with nonmyeloablative HSCT, which is associated with incomplete HLA-matched transplant and complications, and has an important impact on the patients’ first year of survival.

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

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

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

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Baker KS, Wagner JE . Novel conditioning regimens and nonmyeloablative stem cell transplants. Curr Opin Pediatr 2002; 14: 17–22.

    Article  PubMed  Google Scholar 

  2. Champlin RE . Nonmyeloablative hematopoietic transplantation for treatment of malignant diseases. Curr Opin Organ Transplant 2002; 7: 275–278.

    Article  Google Scholar 

  3. Parikh CR, Mcsweeney P, Schrier RW . Acute renal failure independently predicts mortality after myeloablative allogeneic hematopoietic cell transplant. Kidney Int 2005; 67: 1999–2005.

    Article  PubMed  Google Scholar 

  4. Hingorani SR, Guthrie K, Batchelder A, Schoch G, Aboulhosn N, Manchion J et al. Acute renal failure after myeloablative hematopoietic cell transplant: Incidence and risk factors. Kidney Int 2005; 67: 272–277.

    Article  PubMed  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  PubMed  Google Scholar 

  6. Kersting S, Koomans HA, Hene RJ, Verdonck LF . Acute renal failure after allogeneic myeloablative stem cell transplantation: retrospective analysis of incidence, riskfactors and survival. Bone Marrow Transplant 2007; 39: 359–365.

    Article  CAS  PubMed  Google Scholar 

  7. Kersting S, Dorp SV, Tbeobald M, Verdonck LF . Acute renal failure after nonmyeloablative stem cell transplantation in Adults. Biol Blood Marrow Transplant 2008; 14: 125–131.

    Article  CAS  PubMed  Google Scholar 

  8. 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  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  10. Waikar SS, Liu KD, Chertow GM . The incidence and prognostic significance of acute kidney injury. Curr Opin Nephrol Hypertens 2007; 16: 227–236.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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  PubMed  Google Scholar 

  12. Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol 2004; 15: 1597–1605.

    Article  CAS  PubMed  Google Scholar 

  13. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG et al., the Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: R31.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J et al. Consensus conference on acute GVHD grading. Bone Marrow Transplant 1995; 15: 825–828.

    CAS  PubMed  Google Scholar 

  15. 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  PubMed  Google Scholar 

  16. Manjunath G, Sarnak MJ, Levey AS . Prediction equations to estimate glomerular filteration rate: an update. Curr Opin Nephrol Hypertens 2001; 10: 785–792.

    Article  CAS  PubMed  Google Scholar 

  17. Liu H, Ding JH, Liu BC, Zhao G, Chen BA . Early renal injury after nonmyeloablative allogeneic peripheral blood stem cell transplantation in patients with chronic myelocytic leukemia. Am J Nephrol 2007; 27: 336–341.

    Article  PubMed  Google Scholar 

  18. Niederwieser D, Maris M, Shizuru JA, Petersdorf E, Hegenbart U, Sandmaier BM et al. Low-dose total body irradiation (TBI) and fludarabine followed by hematopoietic cell transplantation (HCT) from HLA-matched or mismatched unrelated donors and postgrafting immunosuppression with cyclosporine and mycophenolate mofetil (MMF) can induce durable complete chimerism and sustained remissions in patients with hematological diseases. Blood 2003; 101: 1620–1629.

    Article  CAS  PubMed  Google Scholar 

  19. McSweeney PA, Niederwieser D, Shizuru JA, Sandmaier BM, Molina AJ, Maloney DG et al. Hematopoietic cell transplantation in older patients with hematologic malignancies: replacing high-dose cytotoxic therapy with graft-versus-tumor effects. Blood 2001; 97: 3390–3400.

    Article  CAS  PubMed  Google Scholar 

  20. Gottlieb SS, Abraham W, Butler J, Forman DE, Loh E, Massie BM et al. The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Card Fail 2002; 8: 136–141.

    Article  PubMed  Google Scholar 

  21. Rao PS . Nephrotic syndrome in patients with peripheral blood stem cell transplant. Am J Kidney Dis 2005; 45: 780–785.

    Article  PubMed  Google Scholar 

  22. Szydlo R, Goldman JM, Klein JP, Gale RP, Ash RC, Bach FH et al. Results of allogeneic bone marrow transplants for leukemia using donors other than HLA-identical siblings. J Clin Oncol 1997; 15: 1767–1777.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We acknowledge the fact that this research was supported by a grant from Jiangsu Provincial Key Medical Talent (no. RC 2007072) to Professor Liu BiCheng as PI.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to B-C Liu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liu, H., Li, YF., Liu, BC. et al. A multicenter, retrospective study of acute kidney injury in adult patients with nonmyeloablative hematopoietic SCT. Bone Marrow Transplant 45, 153–158 (2010). https://doi.org/10.1038/bmt.2009.99

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2009.99

Keywords

This article is cited by

Search

Quick links