Section of Hematology-Oncology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
School of Medicine, Baylor College of Medicine, Houston, Texas.
Transplant Cell Ther. 2021 Oct;27(10):864.e1-864.e5. doi: 10.1016/j.jtct.2021.06.027. Epub 2021 Jul 1.
Thrombotic microangiopathy (TMA) after allogeneic hematopoietic cell transplant (HCT) is associated with acute kidney injury (AKI) and increased mortality. The impact of TMA on chronic kidney disease (CKD) and long-term mortality among HCT survivors has not been fully examined. To assess the risk of CKD and mortality in HCT survivors with and without history of TMA, we conducted a retrospective cohort study among adult allogeneic HCT recipients who survived to at least 1 year post-transplantation. We examined the association between the history of TMA within 1 year and the onset of CKD longitudinally for 5 years with generalized estimating equation (GEE) while adjusting for other key confounders. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m using the CKD-EPI formula with outpatient creatinine values collected during the annual long-term follow-up unit follow-up visits. Kaplan Meier curves landmarked at 1 year were used for survival analyses. Among 2091 adult patients who underwent allogeneic HCT, we identified 1151 patients who survived at least 1 year and had available long-term follow-up data. Among them, 57 patients developed TMA within 1 year and 1094 did not have TMA. There was no pretransplantation baseline difference in eGFR between groups. After adjusting for confounders, history of TMA was associated with an odds ratio of 2.83 (95% confidence interval 1.33-6.03) for CKD development over 5 years after transplantation. The conditional 5-year survival was 78% in the TMA survivors and 80% in the non-TMA survivors (log rank P = .122). HCT survivors with a history of TMA had increased risk of CKD development. Although TMA was associated with high risk of mortality within 1 year after transplantation, long-term survival was comparable with non-TMA survivors. Future therapeutic interventions should focus on not only short-term mortality outcomes, but also short- and long-term kidney outcomes for HCT patients with TMA.
异基因造血细胞移植（HCT）后的血栓性微血管病（TMA）与急性肾损伤（AKI）和死亡率增加有关。TMA 对 HCT 幸存者慢性肾脏病（CKD）和长期死亡率的影响尚未得到充分研究。为了评估有和没有 TMA 病史的 HCT 幸存者发生 CKD 和死亡的风险，我们对至少在移植后 1 年存活的成人异基因 HCT 受者进行了回顾性队列研究。我们使用广义估计方程（GEE）在 5 年内纵向检查了 1 年内 TMA 病史与 CKD 发病之间的关联，同时调整了其他关键混杂因素。使用 CKD-EPI 公式根据年度长期随访单位随访期间收集的门诊肌酐值，将 eGFR<60 mL/min/1.73 m 定义为 CKD。Kaplan-Meier 曲线以 1 年为界进行生存分析。在 2091 名接受异基因 HCT 的成年患者中，我们确定了 1151 名至少存活 1 年且有长期随访数据的患者。其中，57 例患者在 1 年内发生 TMA，1094 例患者未发生 TMA。两组患者在移植前 eGFR 无基线差异。在调整混杂因素后，TMA 病史与移植后 5 年内 CKD 发展的比值比相关，为 2.83（95%置信区间 1.33-6.03）。TMA 幸存者的 5 年条件生存率为 78%，非 TMA 幸存者为 80%（对数秩 P=.122）。有 TMA 病史的 HCT 幸存者发生 CKD 的风险增加。尽管 TMA 与移植后 1 年内的高死亡率相关，但长期生存率与非 TMA 幸存者相当。未来的治疗干预措施应不仅关注短期死亡率结局，还应关注 TMA 患者的短期和长期肾脏结局。
