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Analysis of risk factors for fatal renal complications after allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 59, pages 325–333 (2024)Cite this article

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Abstract

Various complications can influence hematopoietic cell transplantation (HCT) outcomes. Renal complications can occur during the early to late phases of HCT along with various factors. However, studies focusing on fatal renal complications (FRCs) are scarce. Herein, we analyzed 36,596 first allogeneic HCT recipients retrospectively. Overall, 782 patients died of FRCs at a median of 108 (range, 0–3,440) days after HCT. The cumulative incidence of FRCs was 1.7% and 2.2% at one and five years, respectively. FRCs were associated with older age, male sex, non-complete remission (non-CR), lower performance status (PS), and HCT comorbidity index (HCT-CI) associated with renal comorbidity in multivariate analysis. The risk factors within 100 days included older age, multiple myeloma, PS, and HCT-CI comorbidities (psychiatric disturbance, hepatic disease, obesity, and renal disease). Older age and male sex were risk factors between 100 days and one year. After one year, HCT-CI was associated with the presence of diabetes and prior solid tumor; total body irradiation was identified as a risk factor. Non-CR was a common risk factor in all three phases. Furthermore, acute and chronic graft-versus-host disease, reactivation of cytomegalovirus, and relapse of underlying disease also affected FRCs. Systematic follow-up may be necessary based on the patients’ risk factors and post-HCT events.

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Fig. 1: Cumulative incidence of death due to renal complications after HCT.
Fig. 2: Analysis of fatal renal complications according to post-HCT events.

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Data availability

The data of this study are not publicly available due to ethical restrictions that it exceeds the scope of the recipient/donor’s consent for research use in the registry.

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Acknowledgements

The authors are grateful to the physicians and data managers at the centers who contributed valuable transplantation data to the JSTCT. We would also like to thank all members of the Transplant Registry Unified Management Committee at the JSTCT for their dedicated data management.

Author information

Authors and Affiliations

  1. Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan

    Ryu Yanagisawa

  2. Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan

    Hiroaki Koyama & Akihito Shinohara

  3. Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan

    Kimikazu Yakushijin

  4. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations TORANOMON HOSPITAL, Tokyo, Japan

    Naoyuki Uchida

  5. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Atsushi Jinguji

  6. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    Wataru Takeda & Takahiro Fukuda

  7. Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan

    Tetsuya Nishida

  8. Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan

    Masatsugu Tanaka

  9. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    Tetsuya Eto

  10. Department of Hematology, Hokkaido University Hospital, Sapporo, Japan

    Hiroyuki Ohigashi

  11. Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Japan

    Kazuhiro Ikegame

  12. Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan

    Ken-ichi Matsuoka

  13. Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan

    Yuta Katayama

  14. Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan

    Yoshinobu Kanda & Hideki Nakasone

  15. Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan

    Masashi Sawa

  16. Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan

    Toshiro Kawakita

  17. Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan

    Makoto Onizuka

  18. Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan

    Yoshiko Atsuta

  19. Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan

    Yoshiko Atsuta

  20. Division of Emerging Medicine for Integrated Therapeutics, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Japan

    Hideki Nakasone

Authors
  1. Ryu Yanagisawa
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  2. Hiroaki Koyama
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  3. Kimikazu Yakushijin
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  4. Naoyuki Uchida
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Contributions

RY designed the study, analyzed the data, and wrote the manuscript. HK, KY and AS designed the study, provided advice on the methods, and wrote the manuscript. NU, AJ, WT, TN, MT, TE, HO, KI, KM, YKatayama, YKanda, MS, and TK collected data and revised the manuscript. MO and TF collected data, revised the manuscript, and was responsible for data management at the JSTCT. YA managed the unified registry database and revised the manuscript. HN designed the study, advised on the methods, revised the manuscript, and was responsible for the JSTCT Transplantation Complications Working Group. All the authors approved the final version of the manuscript.

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Correspondence to Ryu Yanagisawa.

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Yanagisawa, R., Koyama, H., Yakushijin, K. et al. Analysis of risk factors for fatal renal complications after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 59, 325–333 (2024). https://doi.org/10.1038/s41409-023-02172-4

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