ESPN 53rd Annual Meeting

ESPN 2021


 
ACUTE KIDNEY INJURY AFTER ALLOGENEIC HAEMATOPOIETIC CELL TRANSPLANTATION IN CHILDREN – A SINGLE CENTRE OBSERVATIONAL STUDY
Erik Larsson 1 Mikael Sundin 2 Peter Bárány 3 Milan Chromek 3

1- DIVISION OF PAEDIATRICS, DEPARTMENT OF CLINICAL SCIENCES, INTERVENTION AND TECHNOLOGY (CLINTEC), KAROLINSKA INSTITUTET AND ASTRID LINDGREN CHILDREN’S HOSPITAL, KAROLINSKA UNIVERSITY HOSPITAL, STOCKHOLM, SWEDEN
2- DIVISION OF PAEDIATRICS, DEPARTMENT OF CLINICAL SCIENCES, INTERVENTION AND TECHNOLOGY (CLINTEC), KAROLINSKA INSTITUTET AND SECTION OF HAEMATOLOGY, IMMUNOLOGY AND HCT, ASTRID LINDGREN CHILDREN’S HOSPITAL, KAROLINSKA UNIVERSITY HOSPITAL, STOCKHOLM, SWEDEN
3- DIVISION OF PAEDIATRICS, DEPARTMENT OF CLINICAL SCIENCES, INTERVENTION AND TECHNOLOGY (CLINTEC), KAROLINSKA INSTITUTET AND PAEDIATRIC NEPHROLOGY UNIT, ASTRID LINDGREN CHILDREN’S HOSPITAL, KAROLINSKA UNIVERSITY HOSPITAL, STOCKHOLM, SWEDEN
 
Introduction:

The incidence of acute kidney injury (AKI) after paediatric allogeneic haematopoietic cell transplantation (HCT) varies widely (21-53%) and its pathogenesis remains unclear.

Material and methods:

All paediatric patients who underwent HCT in 2015-2017 at our hospital were retrospectively assessed. Clinical and laboratory parameters including plasma creatinine (P-Cr) levels (pre HCT, peak value and at, or as close as possible to, 100 days) were recorded. AKI was defined as a ≥ twofold increase in P-Cr (KDIGO ≥ II).

Results:

Sixty-one HCTs were done in 56 patients (66% boys) with a mean age of 7.5 years (0.1 -17.4). Most patients (51%) had non-malignant indications. Reduced intensity conditioning was more frequent (52%), as was cyclosporine as post-HCT immunosuppression (98%). Median P-Cr was significantly higher at 41 µmol/L 100 days post-HCT compared to 24 µmol/L pre-HCT (p<0.001), corresponding to an eGFR of 96 and 158 ml/min/1.7m2, respectively. AKI was observed in 66% of the patients and 7% of the patients had developed eGFR < 60 ml/min/1.7m2 at the last follow-up. No patient needed renal replacement therapy. AKI incidence was significantly higher in unrelated donor (URD) HCTs compared to other donor-type HCTs (78 vs. 52%, p<0.05). Age was negatively associated with AKI. There was no association between acute GVHD, conditioning, HCT indication, infections, sex or toxic cyclosporine levels and AKI. Occurrence of AKI did not affect eGFR 100 days post-HCT or three-year survival.

Conclusions:

AKI seems to be a very common complication to HCT. However, in this study, AKI was not associated with a worse outcome as measured by eGFR at 100 days or three-year survival. The high pre-HCT eGFR in this study suggests that plasma creatinine may overestimate GFR pre-HCT, which makes diagnosing AKI challenging. The observed association between URD-HCTs and AKI is intriguing and advocates further investigation addressing immunological mechanisms in the pathogenesis of AKI after HCT.