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Kidney Week

Abstract: TH-PO067

High Incidence of Early AKI in Cord Blood Transplantation (CBT) Recipients

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Gutgarts, Victoria, Weill Cornell, New York, New York, United States
  • Zheng, Junting, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Devlin, Sean, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Jacob, Alexandra, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Maloy, Molly A., Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Bhatt, Valkal, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Politikos, Ioannis, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Glezerman, Ilya, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Muthukumar, Thangamani, Weill Cornell, New York, New York, United States
  • Jaimes, Edgar A., Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Jaffer Sathick, Insara, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Barker, Juliet N., Memorial Sloan Kettering Cancer Center, New York, New York, United States
Background

CBT can be curative in patients with high-risk hematologic malignancies but may be associated with a risk of acute kidney injury (AKI).

Methods

We analyzed AKI incidence and risk factors in adult CBT recipients (18-65 years) transplanted for hematologic malignancies with cyclophosphamide/ fludarabine/ thiotepa / TBI 400, cyclosporine (CSA)/ mycophenolate mofetil and double unit CB grafts from 2006-2016. Maximum grade AKI (KDIGO criteria 1, 2 or 3) was calculated using day 0 - +100 creatinines. If patients had multiple episodes, the highest AKI grade was analyzed.

Results

154 patients (median age 51 years) were transplanted. No patient had chronic kidney disease. Median age-adjusted hematopoietic cell transplantation comorbidity index (aaHCT-CI) was 3 (range 0-9). 58 (38%) patients also received haploidentical CD34+ cells. 96% engrafted, 74% had grade II-IV acute graft-vs-host disease (aGVHD), and 138 (90%) were alive/ disease-free at day 100. 125 patients had AKI (41 grade 1, 62 grade 2, 22 grade 3) for a grade 1-3 cumulative incidence of 82% (median onset 30 days, range 0-96) and 54 % for grade 2/3. High-toxic CSA levels (3 day average greater than 350) were seen immediately prior to AKI in 11/41 (27%) patients with grade 1 vs 33/84 (39%) of grade 2-3 patients. There were 29 patients who did not have an AKI event. Significant variables associated with AKI are shown in Table 1.

Conclusion

CBT recipients are at significant risk for AKI. Early recognition and prompt intervention are critical to lessen severe injury. Strategies to mitigate AKI are required as well as analysis of the effect of AKI on long-term renal function.