Acute kidney injury in patients with systemic sclerosis participating in hematopoietic cell transplantation trials in the United States.
Recipients of hematopoietic cell transplantation may be at risk for developing acute kidney injury (AKI), and this risk may be increased in patients who undergo transplantation for severe systemic sclerosis (SSc) due to underlying scleroderma renal disease. AKI after transplantation can increase treatment-related mortality. To better define these risks, we analyzed 91 patients with SSc who were enrolled in 3 clinical trials in the United States of autologous or allogeneic hematopoietic cell transplantation (HCT). Eleven (12%) of the 91 patients with SSc in these studies (8 undergoing autologous HCT, 1 undergoing allogeneic HCT, 1 pretransplantation, 1 given i.v. cyclophosphamide on a transplantation trial) experienced AKI, of whom 8 required dialysis and/or therapeutic plasma exchange. AKI injury in the 9 HCT recipients developed a median of 35 days (range, 0-90 days) after transplantation. Ten of 11 patients with AKI received angiotensin-converting enzyme inhibitor (ACE-I) therapy. The etiology of AKI was attributed to scleroderma renal crisis in 6 patients (including 2 with normotensive renal crisis), to AKI of uncertain etiology in 2 patients, and to AKI superimposed on scleroderma kidney disease in 3 patients. Eight of the 11 patients died, one each because of progression of SSc, multiorgan failure, gastrointestinal and pulmonary bleeding, pericardial tamponade and pulmonary complications, diffuse alveolar hemorrhage, pulmonary embolism, graft-versus-host disease, and malignancy. Limiting nephrotoxins, cautious use of corticosteroids, renal shielding during total body irradiation, strict control of blood pressure, and aggressive use of ACE-Is may be of importance in preventing renal complications after HCT for SSc.
Hosing
Chitra
C
Department of Stem Cell Transplantation and Cellular Therapy, M.D. Anderson Cancer Center, Houston, Texas 77030, USA. cmhosing@mdanderson.org
Nash
Richard
R
McSweeney
Peter
P
Mineishi
Shin
S
Seibold
James
J
Griffith
Linda M
LM
Shulman
Howard
H
Goldmuntz
Ellen
E
Mayes
Maureen
M
Parikh
Chirag R
CR
Crofford
Leslie
L
Keyes-Elstein
Lynette
L
Furst
Daniel
D
Steen
Virginia
V
Sullivan
Keith M
KM
D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010951:Plasma Exchange; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D012307:Risk Factors; D012594:Scleroderma, Localized / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012595:Scleroderma, Systemic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014481:United States; D014916:Whole-Body Irradiation / Q000009:adverse effects
D000806:Angiotensin-Converting Enzyme Inhibitors; D019653:Myeloablative Agonists; D003520:Cyclophosphamide