Abstract: SA-PO194
AKI in Allogeneic Hematopoietic Stem Cell Transplantation
Session Information
- Onco-Nephrology: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Abramson, Matthew, New York Presbyterian-Weill Cornell Medicine, New York, New York, United States
- Zheng, Junting, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Gutgarts, Victoria, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Ruiz, Josel Dumo, 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
- Scordo, Michael, Memorial Sloan Kettering Cancer Center, 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
Background
The reported incidence of Acute Kidney Injury(AKI) after hematopoietic stem cell transplantation (HSCT) varies from 10 to 73%.The association between Graft vs Host Disease(GvHD), calcineurin inhibitors and risk for kidney injury remains controversial.We sought to describe the incidence of AKI and identify modifiable risk factors in patients undergoing allogeneic HSCT in our institution.
Methods
All patients undergoing allogeneic (non-cord) HSCT from 2014 to 2017 in our institution were included. Patient and graft characteristics associated with kidney injury were analyzed. AKI was defined using KDIGO criteria into grades 1, 2 and 3 including all serum creatinines obtained within the first 100 days after transplant. Differences across groups were assessed using either Wilcoxon rank-sum tests or Fisher’s exact tests. AKI risk factors were estimated using cause-specific Cox proportional hazards regression.
Results
A total of 613 consecutive patients underwent allogeneic HSCT during the study period. Median age was 58(19-79) years, 59% male, 83% Caucasian. Indication for HSCT was leukemia in 49%, myelodysplastic syndrome in 16% and lymphoma in 17%. Median baseline creatinine was 0.8 (0.3-2.7) mg/dl. Median age-adjusted HCT-comorbidity index was 3(range 0-9). 97% patients engrafted with median time to engraftment of 12(8-33) days. Cumulative incidence of acute GVHD was 47%. By day100 postHSCT,143(23%) patients had grade 1 AKI, 153(25%) grade 2 AKI, and 78(13%) grade 3 AKI.Tcell depleted HSCT patients had a lower risk for AKI, hazard ratio 0.46 (0.35-0.62), p<0.001 (Table 1).
Conclusion
AKI in patients undergoing HSCT remains a major concern, affecting 61% of patients undergoing allogenic HSCT, with grade 2 and 3 AKI occurring in 25% and 13%, respectively. Patients undergoing T-cell depleted HSCT have lower incidence of AKI. Patients receiving GVHD prophylaxis with regimens including tacrolimus have a significantly higher risk for AKI, hazard ratio 2.63 (2.06-3.33). The effect of AKI after HSCT on long-term kidney function requires further prospective study.