Kang Seok Hui, Park Hoon Suk, Sun In O, Choi Sun Ryoung, Chung Byung Ha, Choi Bum Soon, Min Chang Ki, Do Jun Young, Yang Chul Woo, Kim Yong Soo, Yoon Kyung Woo, Park Cheol Whee
Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, The Yeungnam University of Korea, Seoul, Korea.
Clin Nephrol. 2012 Mar;77(3):225-30. doi: 10.5414/cn107280.
Renal dysfunction after allogeneic hematopoietic stem cell transplantation (HSCT) has been increasingly reported. However, there are few reports on the changes of the estimated glomerular filtration rate (eGFR) in long-term survivors after allogeneic HSCT.
The medical records at Seoul St. Mary's Hospital in Korea were reviewed to identify all adult (> 18-years-of-age) patients who had undergone high-dose chemotherapy and allogeneic HSCT between January 2001 and December 2005. Among these patients, those with < 5 years of follow-up and relapse within 5 years after HSCT were excluded. 85 patients were enrolled.
The mean follow-up was 76.0 ± 13.5 months. The eGFR recorded 3 months after HSCT was significantly decreased compared with the eGFR recorded before HSCT. Subsequently, early decreased eGFR was maintained during the 60 months after HSCT. Multivariate analysis showed that acute kidney injury (AKI) during HSCT, hypertension (HTN) and eGFR before HSCT was differently associated with changes in eGFR. The eGFR in patients who had AKI decreased significantly at 3 months after HSCT. After 3 months, the eGFR recovered to reach a lower level than in patients without AKI. The level was maintained during the 60 months after HSCT. The eGFR in patients who had low eGFR before HSCT (< 90 ml/min) decreased significantly at 3 months after HSCT, which was also maintained during the 60 months after HSCT. The eGFR in patients who had HTN also decreased significantly at 3 months after HSCT. By contrast, the eGFR decreased consistently and slowly from 3 to 60 months.
AKI and low baseline eGFR are associated with early renal dysfunction in patients after HSCT, but are not closely associated with long-term decline in eGFR. In contrast, eGFR in patients with HTN continuously decrease after 3 months of HSCT. Therefore, HTN seems to play a major role in the long-term decline in eGFR. These findings suggest that eGFR at 3 months after HSCT should be monitored closely for all patients who have undergone HSCT. Additionally, long-term follow-up of renal function is needed to prevent further renal damage for patients with HTN.
异基因造血干细胞移植（HSCT）后肾功能障碍的报道日益增多。然而，关于异基因HSCT长期存活者估计肾小球滤过率（eGFR）变化的报道较少。
回顾韩国首尔圣玛丽医院的病历，以确定2001年1月至2005年12月期间接受大剂量化疗和异基因HSCT的所有成年（>18岁）患者。在这些患者中，排除随访时间<5年和HSCT后5年内复发的患者。共纳入85例患者。
平均随访时间为76.0±13.5个月。HSCT后3个月记录的eGFR与HSCT前记录的eGFR相比显著降低。随后，早期降低的eGFR在HSCT后的60个月内维持不变。多因素分析显示，HSCT期间的急性肾损伤（AKI）、高血压（HTN）和HSCT前的eGFR与eGFR的变化有不同关联。发生AKI的患者在HSCT后3个月时eGFR显著降低。3个月后，eGFR恢复到比未发生AKI的患者更低的水平，并在HSCT后的60个月内维持该水平。HSCT前eGFR较低（<90 ml/min）的患者在HSCT后3个月时eGFR显著降低，在HSCT后的60个月内也维持该水平。患有HTN的患者在HSCT后3个月时eGFR也显著降低。相比之下，eGFR从3个月到60个月持续缓慢下降。
AKI和低基线eGFR与HSCT后患者的早期肾功能障碍有关，但与eGFR的长期下降没有密切关联。相比之下，HTN患者的eGFR在HSCT后3个月持续下降。因此，HTN似乎在eGFR的长期下降中起主要作用。这些发现表明，对于所有接受HSCT的患者，应密切监测HSCT后3个月时的eGFR。此外，对于患有HTN的患者，需要进行肾功能的长期随访以预防进一步的肾损伤。
