Kersting S, Koomans H A, Hené R J, Verdonck L F
Department of Haematology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Bone Marrow Transplant. 2007 Mar;39(6):359-65. doi: 10.1038/sj.bmt.1705599.
Acute renal failure (ARF) is an important complication after stem cell transplantation (SCT). We retrospectively analysed ARF in 363 recipients of allogeneic myeloablative SCT to identify incidence, risk factors, associated post-transplantation complications and mortality of ARF. ARF was graded as grade 0 (no ARF) to grade 3 (need for dialysis) according to creatinine, estimated glomerular filtration rate and need for dialysis. The incidence of severe renal failure (grades 2 and 3 combined) was 49.6% (180 of 363 patients). Hypertension present at SCT was identified as a risk factor for ARF (P=0.003). Despite this, survival of these patients was not different compared to patients without hypertension. Admission to the intensive care unit (ICU) was a post-transplantation complication significantly associated with ARF (P<0.001). Survival rate was highest in patients with ARF grade 0-1 and lowest in patients with grade 3 (P<0.001). However, after correction for complications associated with high mortality (admission to the ICU, thrombotic thrombocytopenic purpura, sinusoidal occlusion syndrome (SOS) and acute graft-versus-host disease) the significant difference in survival disappeared, showing that ARF without co-morbid conditions has a good prognosis, and ARF with co-morbid conditions has a poor prognosis. This poor prognosis is due to the presence of co-morbid conditions rather than development of ARF itself.
急性肾衰竭（ARF）是干细胞移植（SCT）后的一种重要并发症。我们回顾性分析了363例接受异基因清髓性SCT患者的ARF情况，以确定ARF的发生率、危险因素、相关的移植后并发症及死亡率。根据肌酐、估计肾小球滤过率及透析需求，将ARF分为0级（无ARF）至3级（需要透析）。严重肾衰竭（2级和3级合并）的发生率为49.6%（363例患者中的180例）。移植时存在的高血压被确定为ARF的一个危险因素（P = 0.003）。尽管如此，这些患者的生存率与无高血压患者相比并无差异。入住重症监护病房（ICU）是与ARF显著相关的移植后并发症（P < 0.001）。ARF 0 - 1级患者的生存率最高，3级患者的生存率最低（P < 0.001）。然而，在校正了与高死亡率相关的并发症（入住ICU、血栓性血小板减少性紫癜、窦性阻塞综合征（SOS）和急性移植物抗宿主病）后，生存率的显著差异消失，表明无合并症的ARF预后良好，合并症的ARF预后不良。这种不良预后是由于合并症的存在而非ARF本身的发展所致。
