Acute Kidney Injury in Pediatric Patients Receiving Allogeneic Hematopoietic Cell Transplantation: Incidence, Risk Factors, and Outcomes

Kyung Nam Koh, Anusha Sunkara, Guolian Kang, Amanda Sooter, Daniel A. Mulrooney, Brandon Triplett, Ali Mirza Onder, John Bissler, Lea C. Cunningham

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Abstract

Acute kidney injury (AKI) is a common adverse event after hematopoietic cell transplantation (HCT). AKI is associated with early death or chronic kidney disease among transplant survivors. However, large-scale pediatric studies based on standardized criteria are lacking. We performed a retrospective analysis of 1057 pediatric patients who received allogeneic HCT to evaluate the incidence and risk factors of AKI according to AKI Network criteria within the first 100 days of HCT. We also determined the effect of AKI on patient survival. The 100-day cumulative incidences of all stages of AKI, stage 3 AKI, and AKI requiring renal replacement therapy (RRT) were 68.2% ± 1.4%, 25.0% ± 1.3%, and 7.6% ±.8%, respectively. Overall survival at 1 year was not different between patients without AKI and those with stage 1 or 2 AKI (66.1% versus 73.4% versus 63.9%, respectively) but was significantly different between patients without AKI and patients with stage 3 AKI with or without RRT requirement (66.1% versus 47.3% versus 7.5%, respectively; P <.001). Age, year of transplantation, donor type, sinusoidal obstruction syndrome (SOS), and acute graft-versus-host disease (GVHD) were independent risk factors for stages 1 through 3 AKI. Age, donor, conditioning regimen, number of HCTs, SOS, and acute GVHD were independent risk factors for AKI requiring RRT. Our study revealed that AKI was a prevalent adverse event, and severe stage 3 AKI, which was associated with reduced survival, was common after pediatric allogeneic HCT. All patients receiving allogeneic HCT, especially those with multiple risk factors, require careful renal monitoring according to standardized criteria to minimize nephrotoxic insults.

LanguageEnglish (US)
Pages758-764
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number4
DOIs
StatePublished - Apr 1 2018

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Cell Transplantation
Acute Kidney Injury
Pediatrics
Incidence
Renal Replacement Therapy
Hepatic Veno-Occlusive Disease
Graft vs Host Disease
Survival
Tissue Donors
Chronic Renal Insufficiency

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

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Acute Kidney Injury in Pediatric Patients Receiving Allogeneic Hematopoietic Cell Transplantation : Incidence, Risk Factors, and Outcomes. / Koh, Kyung Nam; Sunkara, Anusha; Kang, Guolian; Sooter, Amanda; Mulrooney, Daniel A.; Triplett, Brandon; Onder, Ali Mirza; Bissler, John; Cunningham, Lea C.

In: Biology of Blood and Marrow Transplantation, Vol. 24, No. 4, 01.04.2018, p. 758-764.

Research output: Contribution to journalArticle

Koh, Kyung Nam ; Sunkara, Anusha ; Kang, Guolian ; Sooter, Amanda ; Mulrooney, Daniel A. ; Triplett, Brandon ; Onder, Ali Mirza ; Bissler, John ; Cunningham, Lea C. / Acute Kidney Injury in Pediatric Patients Receiving Allogeneic Hematopoietic Cell Transplantation : Incidence, Risk Factors, and Outcomes. In: Biology of Blood and Marrow Transplantation. 2018 ; Vol. 24, No. 4. pp. 758-764.
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abstract = "Acute kidney injury (AKI) is a common adverse event after hematopoietic cell transplantation (HCT). AKI is associated with early death or chronic kidney disease among transplant survivors. However, large-scale pediatric studies based on standardized criteria are lacking. We performed a retrospective analysis of 1057 pediatric patients who received allogeneic HCT to evaluate the incidence and risk factors of AKI according to AKI Network criteria within the first 100 days of HCT. We also determined the effect of AKI on patient survival. The 100-day cumulative incidences of all stages of AKI, stage 3 AKI, and AKI requiring renal replacement therapy (RRT) were 68.2{\%} ± 1.4{\%}, 25.0{\%} ± 1.3{\%}, and 7.6{\%} ±.8{\%}, respectively. Overall survival at 1 year was not different between patients without AKI and those with stage 1 or 2 AKI (66.1{\%} versus 73.4{\%} versus 63.9{\%}, respectively) but was significantly different between patients without AKI and patients with stage 3 AKI with or without RRT requirement (66.1{\%} versus 47.3{\%} versus 7.5{\%}, respectively; P <.001). Age, year of transplantation, donor type, sinusoidal obstruction syndrome (SOS), and acute graft-versus-host disease (GVHD) were independent risk factors for stages 1 through 3 AKI. Age, donor, conditioning regimen, number of HCTs, SOS, and acute GVHD were independent risk factors for AKI requiring RRT. Our study revealed that AKI was a prevalent adverse event, and severe stage 3 AKI, which was associated with reduced survival, was common after pediatric allogeneic HCT. All patients receiving allogeneic HCT, especially those with multiple risk factors, require careful renal monitoring according to standardized criteria to minimize nephrotoxic insults.",
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AU - Mulrooney, Daniel A.

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AU - Onder, Ali Mirza

AU - Bissler, John

AU - Cunningham, Lea C.

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AB - Acute kidney injury (AKI) is a common adverse event after hematopoietic cell transplantation (HCT). AKI is associated with early death or chronic kidney disease among transplant survivors. However, large-scale pediatric studies based on standardized criteria are lacking. We performed a retrospective analysis of 1057 pediatric patients who received allogeneic HCT to evaluate the incidence and risk factors of AKI according to AKI Network criteria within the first 100 days of HCT. We also determined the effect of AKI on patient survival. The 100-day cumulative incidences of all stages of AKI, stage 3 AKI, and AKI requiring renal replacement therapy (RRT) were 68.2% ± 1.4%, 25.0% ± 1.3%, and 7.6% ±.8%, respectively. Overall survival at 1 year was not different between patients without AKI and those with stage 1 or 2 AKI (66.1% versus 73.4% versus 63.9%, respectively) but was significantly different between patients without AKI and patients with stage 3 AKI with or without RRT requirement (66.1% versus 47.3% versus 7.5%, respectively; P <.001). Age, year of transplantation, donor type, sinusoidal obstruction syndrome (SOS), and acute graft-versus-host disease (GVHD) were independent risk factors for stages 1 through 3 AKI. Age, donor, conditioning regimen, number of HCTs, SOS, and acute GVHD were independent risk factors for AKI requiring RRT. Our study revealed that AKI was a prevalent adverse event, and severe stage 3 AKI, which was associated with reduced survival, was common after pediatric allogeneic HCT. All patients receiving allogeneic HCT, especially those with multiple risk factors, require careful renal monitoring according to standardized criteria to minimize nephrotoxic insults.

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