title: GVHD-associated chronic kidney disease after allogeneic haematopoietic cell transplantation.
abstract: Chronic kidney disease (CKD) has been related to allogeneic haematopoietic cell transplantation (HCT) as a late effect caused by a variety of factors. We retrospectively evaluated the development of CKD in 230 patients, aged 34 (5-65) years, who had undergone allogeneic HCT for haematological disease, using sibling or unrelated donors and myeloablative or reduced conditioning regimens. Pre-HCT glomerular filtration rate (GFR) was within normal limits (108±28 mL/min/1.73 m(2)) in patients who did not develop CKD and 95±24 mL/min/1.73 m(2) in those with CKD postHCT, while the GFR 12 months post transplant declined to 104±26 and 69±19 mL/min/1.73 m(2), respectively. CKD incidence was 20.4%, with a median time of development of 6 (3-18) months post transplant. On multivariate analysis, risk factors for CKD were the presence of chronic GVHD (cGVHD; P=0.001), unrelated donor transplantation (P=0.008), post-transplant event of acute kidney injury (AKI) (P=0.002) and older age (P=0.002). In long-term survivors stable significant predictors for CKD were older age at transplantation, cGVHD and AKI. CKD did not influence non-relapse mortality. In our study, cGVHD emerges as an important cause of kidney injury in HCT survivors, regardless of administration of nephrotoxic agents.
authors.affiliation: Haematology Department-BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Sakellari
authors.forename: A
authors.initials: A
authors.lastname: Barbouti
authors.forename: G
authors.initials: G
authors.lastname: Bamichas
authors.forename: D
authors.initials: D
authors.lastname: Mallouri
authors.forename: P
authors.initials: P
authors.lastname: Kaloyannidis
authors.forename: S
authors.initials: S
authors.lastname: Fragidis
authors.forename: I
authors.initials: I
authors.lastname: Batsis
authors.forename: C
authors.initials: C
authors.lastname: Apostolou
authors.forename: A
authors.initials: A
authors.lastname: Karpouza
authors.forename: E
authors.initials: E
authors.lastname: Yannaki
authors.forename: C
authors.initials: C
authors.lastname: Smias
authors.forename: K
authors.initials: K
authors.lastname: Sombolos
authors.forename: A
authors.initials: A
authors.lastname: Anagnostopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000276:immunology; D019172:Transplantation Conditioning / Q000009:adverse effects; D014184:Transplantation, Homologous; D055815:Young Adult