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Acute kidney injury in peripheral blood haploidentical hematopoietic stem cell transplantation: should attract enough attention

Bone Marrow Transplantation volume 57, pages 1448–1450 (2022)Cite this article

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Allogeneic hematopoietic stem cell transplantation (allo-HSCT), as a curative therapy, was widely used for hematological diseases. Although the intense alloreactivity had been effectively controlled and the non-relapse mortality (NRM) has been reduced in haploidentical hematopoietic stem cell transplantation (haplo-HSCT) over the past two decades, there were still many post-transplantation complications to be coped with [1]. Acute kidney injury (AKI), which was often ignored in clinical researches, is one of the most typical complications of allo-HSCT and contributes to increased morbidity and mortality after transplantation [2, 3]. Conditioning regimen, infection, graft-versus-host disease (GVHD), and long-term use of nephrotoxicity drugs may lead to AKI [2, 4]. We retrospectively analyzed the cumulative incidence and risk factors of AKI.

A total of 151 consecutive patients who underwent peripheral blood (PB) haplo-HSCT from February 2013 to December 2020 in Jiangsu Province Hospital were investigated. All patients provided written informed consents authorizing the use of information for research purposes. Conditioning regimens were classified into myeloablative condition regimen and reduced-intensity condition regimen according to its intensity. GVHD prophylaxis was based on cyclosporine (CsA) combined with short term methotrexate (day 1, 15 mg/m2, day 3, 6, 11, 10 mg/m2), rabbit anti-human thymocyte immunoglobulin (10 mg/kg, ATG, Sanofi, France) [5], basiliximab (d0, 20 mg) and mycophenolate mofetil (500 mg orally twice a day, from day −5 to day 30). The serum drug concentration of CsA was routinely monitored twice a week and maintained between 200 and 400 ng/ml. For the patient with AKI, treatment includes discontinuing nephrotoxicity drugs, optimizing volume status and perfusion pressure, monitoring serum creatinine, urine output and proteinuria.

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Fig. 1: The cumulative incidence, risk factors and survival of AKI.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

This study was supported by grants from National Natural Science Foundation of China (81470329).

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Author notes

  1. These authors contributed equally: Yanping Liu, Ziwen Duan

Authors and Affiliations

  1. Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 210029, China

    Yanping Liu, Ziwen Duan, Fang Li, Xiao Zhang, Ruize Chen, Hua Lu, Sixuan Qian, Hanxin Wu, Lijuan Chen, Yu Zhu, Han Zhu & Kourong Miao

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  1. Yanping Liu
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Contributions

YL, ZD, HZ and KM designed the research, analyzed and interpreted data, and wrote the manuscript; FL, XZ, RC, HL, SQ, HW, LC and YL collected and analyzed data, and critically reviewed the manuscript before submission. All authors read and approved the final manuscript.

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Correspondence to Han Zhu or Kourong Miao.

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Liu, Y., Duan, Z., Li, F. et al. Acute kidney injury in peripheral blood haploidentical hematopoietic stem cell transplantation: should attract enough attention. Bone Marrow Transplant 57, 1448–1450 (2022). https://doi.org/10.1038/s41409-022-01731-5

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