CHARLOTTESVILLE, VA – Hematopoietic stem cell transplantation can be a life-saving therapy for many patients with cancer, as well as patients with some nonmalignant hematologic disorders, such as aplastic anemia, sickle cell disease, and certain congenital immune deficiencies.
A review led by University of Virginia Health System and including participation from the West Haven, CT, VAMC, cautioned, however, that kidney injury directly associated with stem cell transplantation might involve a variety of structural and functional abnormalities.
Those might include:
- Vascular (hypertension, thrombotic microangiopathy),
- Glomerular (albuminuria, nephrotic glomerulopathies), and/or
- Tubulointerstitial
The article published in the Clinical Journal of the American Society of Nephrology pointed out that AKI occurs commonly after stem cell transplant, affecting 10%-73% of patients. It advised that the cause is often multifactorial and can include sepsis, nephrotoxic medications, marrow infusion syndrome, hepatic sinusoidal obstruction syndrome, thrombotic microangiopathy, infections, and graft versus host disease.
The authors explained that the risk of post-transplant kidney injury varies depending on patient characteristics, type of transplant (allogeneic vs autologous), and choice of chemotherapeutic conditioning regimen (myeloablative vs. nonmyeloablative).
“Importantly, AKI is associated with substantial morbidity, including the need for KRT in approximately 5% of patients and the development of CKD in up to 60% of transplant recipients,” they wrote. “AKI has been associated universally with higher all-cause and non-relapse mortality regardless of transplant type, and studies have consistently shown extremely high (>80%) mortality rates in those patients requiring acute dialysis.”
Researchers called for early recognition and prompt treatment of kidney injury, saying those are “essential to improving kidney and patient outcomes after hematopoietic stem cell transplantation, and for realizing the full potential of this therapy.”
- Renaghan AD, Jaimes EA, Malyszko J, Perazella MA, Sprangers B, Rosner MH. Acute Kidney Injury and CKD Associated with Hematopoietic Stem Cell Transplantation. Clin J Am Soc Nephrol. 2020;15(2):289-297. doi:10.2215/CJN.08580719