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Acute kidney injury within 100 days post allogeneic hematopoietic cell transplantation is associated with increased risk of post-transplant complications and poor transplant outcomes

Bone Marrow Transplantation volume 57, pages 1411–1420 (2022)Cite this article

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Abstract

Allogeneic hematopoietic cell transplantation (HCT) offers cure for some patients with hematological diseases but is associated with significant risk of morbidity and mortality. We investigated the incidence of AKI and its impact on transplant outcomes among 408 patients transplanted at Princess Margaret Hospital Cancer Centre, Toronto, Canada. The overall incidence of AKI at 100 days was 64.2%. Compared to those with no AKI, patients who developed AKI had inferior 2-y overall survival (OS), 44.7% vs. 62.4% (P = 0.0004), higher 2-y transplant related mortality (TRM) 36.8% vs. 18.7% (P = 0.0003), lower 2-y graft-vs-host disease (GVHD)- and relapse-free survival (GRFS), 21.0% vs. 39.8% (P = 0.0002), and higher 100-day grade 3–4 acute GVHD (aGVHD), 12.4% vs. 6.3% (P = 0.01). There was no difference in 2-y incidence of relapse between the AKI and non-AKI groups, 24.2% vs. 24.3% (P = 0.84), 100-day grade 2–4 aGVHD, 27.7% vs. 25.7 (P = 0.41) or 2-y moderate-severe chronic GVHD, 24.0% vs. 21.6% (P = 0.79). Patients who develop AKI within 100 days of HCT have inferior OS and GRFS with higher rates of TRM and grade 3–4 aGVHD. These results highlight the importance of close monitoring of renal function, multidisciplinary collaboration, and implementation of protective strategies throughout HCT to optimize transplant and kidney outcomes.

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Fig. 1: Outcomes as a function of acute kidney injury (AKI).

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Hans Messner Allogeneic Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada

    Kayla Madsen, Jonas Mattsson & Ivan Pasic

  2. Division of Nephrology, University Health Network, Toronto, Canada

    Karyne Pelletier, Gabrielle Côté & Abhijat Kitchlu

  3. Department of Medicine, University of Toronto, Toronto, Canada

    Karyne Pelletier, Gabrielle Côté, Abhijat Kitchlu, Jonas Mattsson & Ivan Pasic

  4. Biostatistics Department, Princess Margaret Cancer Center, University Health Network, Toronto, Canada

    Shiyi Chen

  5. Gloria and Seymour Epstein Chair in Cell Therapy and Transplantation, Toronto, Canada

    Jonas Mattsson

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  1. Kayla Madsen
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Contributions

All authors, KM, KP, GC, AK, SC, JM, and IP contributed to the study conception and design. Material preparation, data collection and analysis were performed by KM, KP, GC and SC under the supervision of IP. The manuscript was written by KM, revised by IP and all authors commented the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ivan Pasic.

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Madsen, K., Pelletier, K., Côté, G. et al. Acute kidney injury within 100 days post allogeneic hematopoietic cell transplantation is associated with increased risk of post-transplant complications and poor transplant outcomes. Bone Marrow Transplant 57, 1411–1420 (2022). https://doi.org/10.1038/s41409-022-01744-0

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