Long-term renal function after hemopoietic stem cell transplantation in children.
Glomerular function of all long-term survivors who underwent hemopoietic stem cell transplantation (HSCT) from 1991 to 1998 (study I, n=121) was studied retrospectively. In addition, we prospectively analyzed glomerular and tubular function of all long-term surviving children who received an HSCT between 1998 and 2000 (study II, n=41). We found a lower prevalence of children with chronic renal failure (CRF) post-HSCT in our more recent cohort (study II: 10%) as compared to the older cohort (study I: 24%) 5.0 (0.7 s.d.) and 7.6 (2.4 s.d.) year's post-HSCT, respectively. Furthermore, it seems that renal function may stabilize after 1-year post-HSCT. None of the patients required dialysis or antihypertensive medication at long-term follow-up. The sole predictor of CRF in our study was high serum creatinine pre-HSCT (P=0.007), while acute renal failure within 3 months after HSCT (P=0.08) only showed a trend towards predicting CRF. We could not confirm a relation of conditioning with irradiation with CRF post-HSCT, as was shown in several other pediatric and adult studies. Proximal and distal tubular dysfunction only occurred in a minority of long-time survivors of HSCT (3-12 and 9-13%, respectively) and had no clinical consequences.
Kist-van Holthe
J E
JE
Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. j.kist@lumc.nl
Bresters
D
D
Ahmed-Ousenkova
Y M
YM
Goedvolk
C A
CA
Abbink
F C H
FC
Wolterbeek
R
R
Bredius
R G M
RG
Pauwels
E K J
EK
van der Heijden
A J
AJ
D002648:Child; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000209:etiology; D007684:Kidney Tubules / Q000473:pathology; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D013997:Time Factors; D019172:Transplantation Conditioning
D003404:Creatinine