Lopedote Paolo, Xue Elisabetta, Chotivatanapong Julie, Pao Emily C, Wychera Chiara, Dahlberg Ann E, Thur Laurel, Roberts Laura, Baker Kelsey, Gooley Ted A, Hingorani Sangeeta, Milano Filippo
Department of Medicine, St. Elizabeth's Medical Center, Boston University, Boston, MA, United States.
Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.
Front Oncol. 2023 May 16;13:1186503. doi: 10.3389/fonc.2023.1186503. eCollection 2023.
Acute kidney injury (AKI) is a frequent early complication post hematopoietic stem cell transplant (HSCT), associated with high morbidity and mortality. Cord blood transplant (CBT) recipients are potentially exposed to more nephrotoxic insults, compared to patients undergoing HSCT from other donor sources. We aimed to identify risk factors for AKI in patients undergoing CBT. We also aimed to identify the impact of AKI on chronic kidney disease (CKD) and survival outcomes by one-year post-CBT.
Adults and children who underwent a first CBT at our Institution were retrospectively evaluated. AKI was staged according to Kidney Disease Improving Global Outcomes (KDIGO) definitions. Cox regression models were used to estimate the association of demographic factors and post-CBT parameters with the cause-specific hazard of AKI.
We identified 276 patients. Median age was 32 years, 28% (77/276) were children (<18 years) and 129 (47%) were white. A myeloablative conditioning regimen was administered to 243 patients (88%) and 248 (90%) received cyclosporine for GVHD prophylaxis. One-hundred and eighty-six patients (67%) developed AKI by day 60 post-transplant, with 72 (26%) developing severe AKI (stage 2 and 3). In a multivariable analysis, each increase in bilirubin level of 1 mg/dL was associated with a 23% increase in the risk of severe AKI (adjusted HR 1.23, 95% CI 1.13 - 1.34, p<.0001). Conversely, systemic steroid administration appeared to be protective of severe AKI (unadjusted HR 0.36, 95% CI 0.18 - 0.72, p=.004) in a univariate model . Two-hundred-forty-seven patients were evaluable at the one-year time point. Among those, 100 patients (40%) developed CKD one-year post-CBT. Severe AKI was associated with a higher hazard of non-relapse mortality (adjusted HR=3.26, 95% CI 1.65-6.45, p=.001) and overall mortality (adjusted HR=2.28, 95% CI 1.22-4.27, p=.01).
AKI is a frequent complication after CBT and is associated with worse outcomes. Questions remain as to the mechanism of the protective role of steroids on kidney function in the setting of CBT.
急性肾损伤（AKI）是造血干细胞移植（HSCT）后常见的早期并发症，与高发病率和死亡率相关。与接受其他供体来源HSCT的患者相比，脐血移植（CBT）受者可能面临更多肾毒性损伤。我们旨在确定接受CBT患者发生AKI的危险因素。我们还旨在确定AKI对CBT后一年慢性肾脏病（CKD）和生存结局的影响。
对在我们机构接受首次CBT的成人和儿童进行回顾性评估。AKI根据改善全球肾脏病预后组织（KDIGO）的定义进行分期。使用Cox回归模型估计人口统计学因素和CBT后参数与AKI特定病因风险的关联。
我们纳入了276例患者。中位年龄为32岁，28%（77/276）为儿童（<18岁），129例（47%）为白人。243例患者（88%）接受了清髓性预处理方案，248例（90%）接受环孢素预防移植物抗宿主病（GVHD）。186例患者（67%）在移植后60天内发生AKI，其中72例（26%）发生严重AKI（2期和3期）。在多变量分析中，胆红素水平每升高1mg/dL，严重AKI风险增加23%（调整后风险比1.23，95%可信区间1.13 - 1.34，p<0.0001）。相反，在单变量模型中，全身使用类固醇似乎对严重AKI有保护作用（未调整风险比0.36，95%可信区间0.18 - 0.72，p = 0.004）。247例患者在一年时间点可进行评估。其中，100例患者（40%）在CBT后一年发生CKD。严重AKI与非复发死亡率（调整后风险比=3.26，95%可信区间1.65 - 6.45，p = 0.001）和总死亡率（调整后风险比=2.28，95%可信区间1.22 - 4.27，p = 0.01）的更高风险相关。
AKI是CBT后常见的并发症，与更差的结局相关。关于在CBT背景下类固醇对肾功能保护作用的机制仍存在疑问。
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