Department of Pediatrics, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan.
Division of Nephrology, Saitama Children's Medical Center, Saitama, Japan.
BMC Nephrol. 2020 Aug 27;21(1):373. doi: 10.1186/s12882-020-02045-8.
Acute kidney injury (AKI) remains a frequent complication in children undergoing hematopoietic stem cell transplantation (HSCT) and an independent risk factor of the patient's survival and a prognostic factor of progression to chronic kidney disease (CKD). However, the causes of these complications are diverse, usually overlapping, and less well understood.
This retrospective analysis was performed in 43 patients (28 boys, 15 girls; median age, 5.5 years) undergoing HSCT between April 2006 and March 2019. The main outcome was the development of AKI defined according to the Pediatric Risk, Injury, Failure, Loss, End-stage Renal Disease (pRIFLE) criteria as ≥ 25% decrease in estimated creatinine clearance. The secondary outcome was the development of CKD after a 2-year follow-up.
AKI developed in 21 patients (49%) within 100 days after HSCT. After adjusting for possible confounders, posttransplant AKI was associated with matched unrelated donor (MUD) (HR, 6.26; P = 0.042), but not total body irradiation (TBI). Of 37 patients who were able to follow-up for 2 years, 7 patients died, but none had reached CKD during the 2 years after transplantation.
Posttransplant AKI was strongly associated with HSCT from MUD. Although the incidence of AKI was high in our cohort, that of posttransplant CKD was lower than reported previously in adults. TBI dose reduced, GVHD minimized, and infection prevented are required to avoid late renal dysfunction after HSCT in children since their combinations may contribute to the occurrence of AKI.
急性肾损伤（AKI）仍然是儿童接受造血干细胞移植（HSCT）后常见的并发症，是患者生存的独立危险因素，也是进展为慢性肾脏病（CKD）的预后因素。然而，这些并发症的原因多种多样，通常重叠，且了解较少。
本回顾性分析纳入了 2006 年 4 月至 2019 年 3 月期间接受 HSCT 的 43 例患者（28 名男孩，15 名女孩；中位年龄 5.5 岁）。主要结局为根据小儿风险、损伤、衰竭、损失、终末期肾脏疾病（pRIFLE）标准定义的 AKI 发展，即估算肌酐清除率下降≥25%。次要结局为 2 年后 CKD 的发展。
21 例患者（49%）在 HSCT 后 100 天内发生 AKI。在调整了可能的混杂因素后，移植后 AKI 与匹配的无关供体（MUD）相关（HR，6.26；P=0.042），但与全身照射（TBI）无关。在 37 例能够随访 2 年的患者中，有 7 例死亡，但在移植后 2 年内均未达到 CKD。
移植后 AKI与来自 MUD 的 HSCT 密切相关。尽管本队列的 AKI 发生率较高，但移植后 CKD 的发生率低于以前报道的成人。需要减少 TBI 剂量、最小化 GVHD、预防感染，以避免儿童 HSCT 后出现肾功能障碍，因为它们的组合可能导致 AKI 的发生。
