title: Risk factors associated with kidney injury and the impact of kidney injury on overall survival in pediatric recipients following allogeneic stem cell transplant.
abstract: Pediatric allogeneic stem cell transplant (AlloSCT) patients are at substantial risk of developing kidney injury (KI), and KI contributes to transplant-related morbidity and mortality. We compared the estimated creatinine clearance (eCrCl) at 1, 3, 6, 9, and 12 months post-AlloSCT in 170 patients following reduced toxicity conditioning (RTC) versus myeloablative conditioning (MAC) to baseline. eCrCl was calculated using the Schwartz equation. Patients with ≥ 50% drop in eCrCl from the baseline were considered to have KI. Patients received tacrolimus and mycophenolate mofetil (MMF) for graft-versus-host disease (GVHD) prophylaxis. The logistic regression model was used for assessing risk factors for KI. Seventy-six patients (median age = 10.6 years) received RTC AlloSCT; 94 patients (median age = 8.5 years) received MAC AlloSCT. The incidence of KI at 1 month post-AlloSCT was significantly higher in MAC versus RTC AlloSCT (43/94 [45.7%] versus 13/76 [17.1%] P < .0001). There was no statistical difference in KI at 3, 6, 9, and 12 months post-AlloSCT between the 2 conditioning groups. On multivariate analysis, only MAC was a significant risk factor for KI (odds radio [OR] 3.44, 95% confidence interval [CI] 1.59-7.42, P = .002). In multivariate analysis for risk factors affecting overall survival (OS), the following were statistically significant: MAC versus RTC (hazard ratio [HR] 2.66, P = .0008), average versus poor-risk disease status (HR 2.09, P = .004), matched sibling donor (MSD) and matched unrelated donor (MUD) versus umbilical cord blood (UCB) (HR 2.31, P = .013), no KI versus KI (HR 2.00, P = .005). In children, MAC is associated with significant risk of KI in the first month after transplant, and KI in the first month post-AlloSCT is associated with a significantly decreased OS.
authors.affiliation: Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University, New York, NY, USA. ps2087@columbia.edu
authors.forename: Prakash
authors.initials: P
authors.lastname: Satwani
authors.forename: Sejal
authors.initials: S
authors.lastname: Bavishi
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.forename: Judith S
authors.initials: JS
authors.lastname: Jacobson
authors.forename: Courtney
authors.initials: C
authors.lastname: Baker
authors.forename: Deirdre
authors.initials: D
authors.lastname: Duffy
authors.forename: Leora
authors.initials: L
authors.lastname: Lowe
authors.forename: Erin
authors.initials: E
authors.lastname: Morris
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007668:Kidney / Q000293:injuries*; D007674:Kidney Diseases / Q000209:etiology / Q000401:mortality*; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D009369:Neoplasms / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation; D015996:Survival Rate; D016559:Tacrolimus / Q000008:administration & dosage; D013997:Time Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus