Guangzhou University of Chinese Medicine, Guangzhou, China.
The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Pediatr Nephrol. 2024 Feb;39(2):397-408. doi: 10.1007/s00467-023-05964-4. Epub 2023 Apr 20.
Risk factors for acute kidney injury (AKI) in pediatric patients after hematopoietic stem cell transplantation (HSCT) remain controversial.
This study aimed to identify risk factors for AKI following HSCT in the pediatric population.
PubMed, Embase, Web of Science, Cochrane Library, and Scopus databases were searched from inception to February 8, 2023.
Studies meeting the following criteria were included: (1) The study was a case-control, cohort study, or cross-sectional design, (2) the study was performed among pediatric and young patients aged 21 years or younger undergoing HSCT, (3) the study measured at least one related factor for AKI after pediatric HSCT, (4) the study included a sample of at least ten patients, and (5) original articles published in English in peer-reviewed scientific journals.
Children who were undergoing pediatric HSCT.
We assessed the quality of the included studies and analyzed them with a random-effect model.
Fifteen studies with a total of 2,093 patients were included. All were cohort studies of high quality. The overall pooled incidence of AKI was 47.4% (95%CI 0.35, 0.60). We found significant associations between post-transplant AKI in pediatric patients and unrelated donor [odds ratio (OR) = 1.74, 95% confidence interval (CI) 1.09-2.79], cord blood stem cell transplantation (OR = 3.14, 95%CI 2.14-4.60), and veno-occlusive disease (VOD)/sinusoidal obstruction syndrome (SOS) (OR = 6.02, 95%CI 1.40-25.88). Other controversial factors such as myeloablative conditioning (MAC), acute graft vs. host disease (aGVHD), and the use of calcineurin inhibitors (CNI) were not found to be related to AKI after pediatric HSCT.
Results were limited mainly by heterogeneity in the characteristics of patients and transplantation.
Posttransplant AKI in children is a common complication. Unrelated donors, cord blood stem cell transplantation, and VOD/SOS might be risk factors for AKI after pediatric HSCT. Further large-scale studies are still needed to draw firm conclusions.
CRD42022382361 A higher resolution version of the Graphical abstract is available as Supplementary information.
造血干细胞移植（HSCT）后儿科患者急性肾损伤（AKI）的危险因素仍存在争议。
本研究旨在确定儿科人群 HSCT 后 AKI 的危险因素。
从建库到 2023 年 2 月 8 日，检索了 PubMed、Embase、Web of Science、Cochrane 图书馆和 Scopus 数据库。
（1）研究为病例对照、队列研究或横断面设计；（2）研究对象为接受 HSCT 的儿科和年轻患者（年龄 21 岁或以下）；（3）研究测量了至少一项与儿科 HSCT 后 AKI 相关的因素；（4）研究纳入了至少 10 例患者；（5）发表在同行评议的科学期刊上的英文原始文章。
接受儿科 HSCT 的儿童。
我们评估了纳入研究的质量，并使用随机效应模型进行了分析。
共纳入 15 项研究，总计 2093 例患者。所有研究均为高质量的队列研究。儿科患者移植后 AKI 的总体合并发生率为 47.4%（95%CI 0.35，0.60）。我们发现，儿科患者移植后 AKI 与无关供体[比值比（OR）=1.74，95%置信区间（CI）1.09-2.79]、脐血干细胞移植（OR=3.14，95%CI 2.14-4.60）和静脉阻塞性疾病（VOD）/窦状隙阻塞综合征（SOS）（OR=6.02，95%CI 1.40-25.88）显著相关。其他有争议的因素，如清髓性预处理（MAC）、急性移植物抗宿主病（aGVHD）和钙调磷酸酶抑制剂（CNI）的使用，与儿科 HSCT 后 AKI 无关。
结果主要受到患者和移植特征的异质性限制。
儿童移植后 AKI 是一种常见的并发症。无关供体、脐血干细胞移植和 VOD/SOS 可能是儿科 HSCT 后 AKI 的危险因素。仍需要进一步的大规模研究来得出确定的结论。
CRD42022382361 可在补充材料中获取更清晰的图表摘要。
