title: Acute kidney injury in patients with systemic sclerosis participating in hematopoietic cell transplantation trials in the United States.
abstract: 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.
authors: Department of Stem Cell Transplantation and Cellular Therapy, M.D. Anderson Cancer Center, Houston, Texas 77030, USA. cmhosing@mdanderson.org
authors: Chitra
authors: C
authors: Hosing
authors: Richard
authors: R
authors: Nash
authors: Peter
authors: P
authors: McSweeney
authors: Shin
authors: S
authors: Mineishi
authors: James
authors: J
authors: Seibold
authors: Linda M
authors: LM
authors: Griffith
authors: Howard
authors: H
authors: Shulman
authors: Ellen
authors: E
authors: Goldmuntz
authors: Maureen
authors: M
authors: Mayes
authors: Chirag R
authors: CR
authors: Parikh
authors: Leslie
authors: L
authors: Crofford
authors: Lynette
authors: L
authors: Keyes-Elstein
authors: Daniel
authors: D
authors: Furst
authors: Virginia
authors: V
authors: Steen
authors: Keith M
authors: KM
authors: Sullivan
mesh_terms: 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
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D019653:Myeloablative Agonists; D003520:Cyclophosphamide