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Kidney Week

Abstract: TH-PO071

AKI in Stem Cell Transplant Patients: Role of Hemoglobinuria

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Kompotiatis, Panagiotis, Mayo Clinic, Rochester, Minnesota, United States
  • Manohar, Sandhya, Mayo Clinic, Rochester, Minnesota, United States
  • Leung, Nelson, Mayo Clinic, Rochester, Minnesota, United States
Background

The available evidence regarding the risk factors of hemoglobinuria shortly after hematopoietic stem cell transplant (HSCT) and its association with outcomes including acute kidney injury (AKI), mortality, and engraftment is very limited.

Methods

The objectives of this study were: 1. Identify risk factors of hemoglobinuria within 24 hours of HSCT
2. Assess whether hemoglobinuria is a risk factor for early post-HSCT AKI 3. Assess outcomes (mortality, engraftment, and infection) with AKI as the predictor in the group of patients with post-HSCT hemoglobinuria.
Methods: Retrospective cohort study of adults that underwent hematopoietic stem cell transplantation from January 6, 1999, to November 6, 2017. Patients that underwent bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT) were included in the study (n= 5992). Of these, we identified 50 patients that developed gross hemoglobinuria within 24 hours after HSCT (In 7 out of 50 patients gross hemoglobinuria was confirmed with urinalysis).

Results

Univariable analysis showed that post-HSCT hemoglobinuria was associated with graft type (BMT vs. PBSCT, OR 12.99 CI 7.3-23.16), underlying disease (lymphoma OR 13.82, CI 4.2-45.43, acute leukemia OR 7.79, CI 1.94-31.22, reference group: multiple myeloma) and fludarabine-based conditioning regimen (OR 2.4, CI 1.09-5.47). In multivariable analysis these associations persisted for all predictors except for acute leukemia. Of the 11 patients that underwent allogeneic HSCT and had hemoglobinuria, only one had a transplant with ABO mismatch (bidirectional). ABO incompatibility hence, was not included in the analysis. Additionally, post-HSCT hemoglobinuria was also associated with early (48-72h) posttransplant AKI (OR 6.3, CI 3.4 -11.7) in univariable analysis. Finally, AKI in patients with hemoglobinuria was associated with delayed platelet engraftment (P= 0.049) but not white blood cells (WBC) engraftment (P=0.11), infection (P=0.77) or 100-day mortality (P=0.52).

Conclusion

Our study demonstrated a significant association between post-HSCT hemoglobinuria and graft type (BMT), fludarabine-based conditioning regimen and underlying disease (lymphoma). Hemoglobinuria was also associated with early post-Tx AKI. Future studies should focus on preventing post-HSCT hemoglobinuria induced AKI in these high-risk patients.