title: Epidemiology, risk factors, and prognosis of capillary leak syndrome in pediatric recipients of stem cell transplants: a retrospective single-center cohort study.
abstract: CLS involves sudden loss of intravascular fluids into the interstitial spaces. CLS was described as a possible complication after SCT. Few studies report the incidence of CLS in pediatric populations. We aimed to assess CLS incidence, its risk factors, and impact on the survival. The clinical charts of patients <18 years of age transplanted at our institution between 2002 and 2012 were reviewed. CLS was defined by weight gain >3% in 24 hours and positive intake balance despite furosemide administration. In total, 234 patients underwent 275 allogeneic SCT procedures in the analyzed time frame. Fifteen patients developed CLS (5.4%). The probability of developing CLS was significantly increased in patients suffering from sepsis (14.3% vs 0.6%, P<.001). Patients with CLS exhibited an increased risk of acute GvHD in the first 30 days after SCT (10.8% vs 1.8%, P=.002). Ten of the patients with CLS required intensive care. CLS strongly impacts OS at day +100 after SCT and is a predictive factor of TRM at the same date (42.9% vs 5%, P<.0001). The biological relation among sepsis, GvHD, and CLS development in terms of cytokine release and endothelial damage warrants further studies.
authors.affiliation: Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany.|Stem Cell Transplantation Unit, Pediatric Department, Great Ormond Street Hospital, London, United Kingdom.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Lucchini
authors.affiliation: Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany.
authors.forename: Andre Manfred
authors.identifier: http://orcid.org/0000-0001-6798-8998
authors.initials: AM
authors.lastname: Willasch
authors.affiliation: Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Daniel
authors.affiliation: Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Soerensen
authors.affiliation: Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Jarisch
authors.affiliation: Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany.
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Bakhtiar
authors.affiliation: Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Rettinger
authors.affiliation: Intensive Care Unit, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Brandt
authors.affiliation: Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Klingebiel
authors.affiliation: Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Bader
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001835:Body Weight; D019559:Capillary Leak Syndrome / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D016207:Cytokines / Q000378:metabolism; D005260:Female; D006086:Graft vs Host Disease; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000503:physiopathology; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D016207:Cytokines
keywords: capillary leak syndrome; complications after stem cell transplantation; endothelial damage