Nurse D P, Li H, Cenin D, Patel S, Dima D, Edwards J, Farlow S, Bragg A, Mehdi A, Hanna R, Rotz S J, Jagadeesh D, Gerds A T, Dean R M, Pohlman B, Hamilton B K, Brunstein C, Kalaycio M, Sauter C S, Sobecks R M
Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
Bone Marrow Transplant. 2025 Apr 2. doi: 10.1038/s41409-025-02556-8.
Pretransplant renal dysfunction has historically been associated with increased non-relapse mortality (NRM) and inferior overall survival. Novel approaches in conditioning and GVHD prophylaxis have reduced the toxicity of transplant over time, however, the impact of pre-transplant eGFR in the contemporary era is unknown. The aim of this study was to identify a pre-transplant eGFR value associated with increased transplant-related mortality. This retrospective study was performed using data from 724 adult patients who underwent first allogeneic hematopoietic cell transplant (alloHCT) from January 2012 through December 2021. The optimal pre-transplant eGFR value for risk of NRM was identified using Cox-restricted cubic spline plot analysis. Those with an eGFR <70 ml/min had the highest risk for NRM (p < 0.0001). Multivariate analysis confirmed that the risk of NRM remained significantly higher for eGFR <70 ml/min compared to the other higher eGFR categories, while there were no significant differences between the higher eGFR categories. Pre-transplant renal dysfunction is associated with poor outcomes after alloHCT and remains an important criterion when considering patients for transplant. Efforts to preserve renal function prior to transplant by limiting nephrotoxic exposures may have implications for optimizing outcomes after transplant, particularly in patients with other comorbidities.
历史上，移植前肾功能不全一直与非复发死亡率（NRM）增加和总体生存率较低相关。随着时间的推移，预处理和移植物抗宿主病（GVHD）预防方面的新方法降低了移植的毒性，然而，在当代，移植前估算肾小球滤过率（eGFR）的影响尚不清楚。本研究的目的是确定与移植相关死亡率增加相关的移植前eGFR值。这项回顾性研究使用了2012年1月至2021年12月期间接受首次异基因造血细胞移植（alloHCT）的724例成年患者的数据。使用Cox受限立方样条图分析确定NRM风险的最佳移植前eGFR值。eGFR<70 ml/min的患者NRM风险最高（p<0.0001）。多变量分析证实，与其他较高eGFR类别相比，eGFR<70 ml/min的患者NRM风险仍然显著更高，而较高eGFR类别之间没有显著差异。移植前肾功能不全与alloHCT后的不良预后相关，并且在考虑患者进行移植时仍然是一个重要标准。通过限制肾毒性暴露在移植前保护肾功能的努力可能对优化移植后的结果有影响，特别是在有其他合并症的患者中。
