Abboud Imad, Porcher Raphaël, Robin Marie, de Latour Régis Peffault, Glotz Denis, Socié Gérard, Peraldi Marie-Noëlle
Department of Nephrology and Transplantation, St. Louis Hospital, Paris, France.
Biol Blood Marrow Transplant. 2009 Oct;15(10):1251-7. doi: 10.1016/j.bbmt.2009.05.016.
Allogeneic hematopoietic stem cell transplantation (HSCT) is the treatment of choice for a wide range of diseases, but is associated with a significant risk of chronic kidney disease (CKD), affecting up to 25% of survivors with a significant morbidity. The causes of CKD after HSCT vary between different studies. The present study evaluated CKD in patients undergoing allogeneic HSCT. We analyzed the clinical course of 148 patients who received allogeneic HSCT at the University Hospital of St. Louis in Paris between 1999 and 2002 and were alive after 2 years without relapse. CKD was defined as a glomerular filtration rate (GFR) <60 mL/min/1.73 m(2), using the abbreviated modification of diet in renal disease (MDRD) equation for adults and the Schwartz formula for children. Of the 148 relapse-free 2-year survivors, 11 (7%) patients had renal dysfunction. No chronic renal failure was noted in the younger age group (<15 years at transplantation). CKD was associated with total body irradiation (TBI) (odds ratio [OR] = 4.53; 95% confidence interval [CI] 1.15 to 17.9; P = .026) and chronic graft-versus-host disease (cGVHD) (OR = 4.58; 95% CI 1.16-18.1; P = .026). Only 1 additional patient developed CKD between 2 and 5 years of follow-up (cumulative incidence of 0.7% over the 3-year period). In the CKD group, renal function tended to stabilize over the 3-year period (estimated GFR 45 +/- 14 mL/min/1.73 m(2) at 2 years and 46 +/- 14 mL/min/1.73 m(2) at 5 years). A 7% prevalence of CKD was noted in the relapse-free 2-year survivor patients. Renal impairement was correlated with TBI and cGVHD. Minor incidence of CKD and a relative stability of renal function were noted between 2 and 5 years after HSCT.
异基因造血干细胞移植（HSCT）是多种疾病的首选治疗方法，但与慢性肾脏病（CKD）的显著风险相关，高达25%的幸存者受其影响，且发病率较高。HSCT后CKD的病因在不同研究中有所不同。本研究评估了接受异基因HSCT患者的CKD情况。我们分析了1999年至2002年期间在巴黎圣路易斯大学医院接受异基因HSCT且2年后无复发存活的148例患者的临床病程。CKD定义为肾小球滤过率（GFR）<60 mL/min/1.73 m²，成人使用简化的肾脏病饮食改良（MDRD）方程，儿童使用施瓦茨公式。在148例2年无复发存活者中，11例（7%）患者存在肾功能障碍。较年轻年龄组（移植时<15岁）未发现慢性肾衰竭。CKD与全身照射（TBI）（优势比[OR]=4.53；95%置信区间[CI]1.15至17.9；P=.026）和慢性移植物抗宿主病（cGVHD）（OR=4.58；95%CI 1.16 - 18.1；P=.026）相关。在随访的2至5年期间，仅1例额外患者发生CKD（3年累积发病率为0.7%）。在CKD组中，肾功能在3年期间趋于稳定（2年时估计GFR为45±14 mL/min/1.73 m²，5年时为46±14 mL/min/1.73 m²）。在2年无复发存活患者中，CKD患病率为7%。肾功能损害与TBI和cGVHD相关。HSCT后2至5年期间，CKD发病率较低，且肾功能相对稳定。
