title: Long term renal survival in patients undergoing T-Cell depleted versus conventional hematopoietic stem cell transplants.
abstract: Calcineurin inhibitor (CNI)-sparing T-cell depleted (TCD) hematopoietic stem cell transplants (HSCTs) are presumed to be less nephrotoxic than conventional HSCTs. We evaluated incidence and risk factors for kidney failure and chronic kidney disease (CKD) in 231 TCD and 212 conventional HSCT recipients. Kidney failure required a median glomerular filtration rate (GFR) <60 ml/min/1.73 m2for ⩾100 days anytime after 180-days post-HSCT. Two-year cumulative incidence (CI) of kidney failure was 42% in the conventional versus 31% in the TCD group (P=0.005). TCD, age, acute kidney injury and number of toxic CNI levels all impacted on kidney failure, which was associated with increased all-cause mortality (hazard ratio 2.86 (95% CI: 1.88-4.36), P<0.001). Renal recovery occurred in 28% of kidney failure patients whereas the remaining patients were defined to have CKD. In those with baseline GFR>60 ml/min/1.73 m2, only exposure to nephrotoxic medications was associated with CKD (P=0.033). In the myeloablative-conditioning subgroup only total body irradiation was associated with CKD (P=0.013). Of all patients, five (1.13%) required dialysis. These results confirm an impact of TCD on kidney failure but not CKD for which other risk factors such as radiation or nephrotoxic drug exposure may have a role.
authors.affiliation: Department of Medicine, Renal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: I G
authors.initials: IG
authors.lastname: Glezerman
authors.affiliation: Department of Epidemiology Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Devlin
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplant Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Maloy
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Bui
authors.affiliation: Department of Medicine, Renal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Jaimes
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, NY, USA.|Department of Medicine, Adult Bone Marrow Transplant Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Giralt
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, NY, USA.|Department of Medicine, Adult Bone Marrow Transplant Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Jakubowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors / Q000627:therapeutic use / Q000633:toxicity; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods / Q000592:standards; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008212:Lymphocyte Depletion / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000209:etiology*; D012307:Risk Factors; D013534:Survival; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D055815:Young Adult
chemical_list: D065095:Calcineurin Inhibitors