title: Long-term renal outcome after allogeneic hemopoietic stem cell transplant: A comprehensive analysis of risk factors in an Asian patient population.
abstract: Allogeneic hemopoietic stem cell transplantation (allo-HSCT) poses a significant challenge to renal function due to multiple drug- and complication-related renal toxicity. In this single-center series of 216 adult Asian patients with a long and complete follow-up, 41 developed chronic kidney disease (CKD) giving a cumulative incidence of 19.0% at 25 years (median follow-up duration 7.84 years, range 2.0-27.7 years), but only two of the 41 patients reached stage 4 CKD and another two required dialysis. In contrast, acute kidney injury occurred in most patients, where glomerular filtration rate (GFR) suffered a mean fall of 50 mL/min/1.73 m2at 6 months post-transplant compared with baseline. Suppression of renal function may last beyond 6 months but is potentially reversible, although not to baseline level in most patients. Analysis of a comprehensive range of 18 risk factors showed that older age, lower GFR at transplant, unrelated donor, diagnosis of AML, presence of diabetes mellitus at transplant, and duration of foscarnet use were significantly associated with CKD development, with the first three remaining as independent risks for CKD in multivariate analysis. Long-term survival is not affected by renal function, being 78.6% as compared to 85.5% for patients with low vs normal GFR at 2 years, respectively.
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhou
authors.affiliation: Duke-NUS Medical School, Singapore, Singapore.
authors.forename: Rehena
authors.initials: R
authors.lastname: Sultana
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Colin
authors.initials: C
authors.lastname: Diong
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Yeow-Tee
authors.initials: YT
authors.lastname: Goh
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Sathish
authors.initials: S
authors.lastname: Gopalakrishnan
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Aloysius
authors.initials: A
authors.lastname: Ho
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: William
authors.initials: W
authors.lastname: Hwang
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Liang-Piu
authors.initials: LP
authors.lastname: Koh
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Mickey
authors.initials: M
authors.lastname: Koh
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore, Singapore.|Raffles Cancer Centre, Singapore, Singapore.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Loh
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Patrick
authors.initials: P
authors.lastname: Tan
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Yeh-Ching
authors.identifier: 0000-0001-8098-2590
authors.initials: YC
authors.lastname: Linn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology*; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D014184:Transplantation, Homologous; D055815:Young Adult
keywords: acute kidney injury; allogeneic hemopoietic stem cell transplant; chronic kidney disease; glomerular filtration rate; long-term survival