Abstract: SA-PO198
AKI and Mortality in Umbilical Cord Transplant Recipients
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
- Hingorani, Sangeeta R., Seattle Children’s Hospital, Seattle, Washington, United States
- Chotivatanapong, Julie, Fred Hutchinson Cancer Research Center, Timonium, Maryland, United States
- Pao, Emily C., Seattle Children’s Hospital, Seattle, Washington, United States
- Baker, Kelsey, Fred Hutchinson Cancer Research Center, Timonium, Maryland, United States
- Milano, Filippo, Fred Hutchinson Cancer Research Center, Timonium, Maryland, United States
Background
Kidney injury occurs commonly after hematopoietic cell transplant (HCT) and negatively impacts outcomes. Umbilical cord blood transplantation (UCBT) is an established treatment for hematological malignancies. We sought to determine the incidence of, risk factors for, and outcomes in patients with AKI after UCBT.
Methods
Patients receiving a first UBCT at our Institution from 2006 to 2017 were included in this retrospective cohort study. AKI was defined by KDIGO stages 1-3 within the first 60 days post-transplant. Risk factors included age, gender, conditioning regimen, indication for transplant, graft vs. host disease (GVHD) prophylaxis, disease severity and clinical variables including acute GVHD, viral and bacterial infections. Cox regression models were used to identify risk factors for AKI and associations with non-relapse mortality.
Results
276 patients were included in this study. 114 (41%) of patients developed Stage 1 AKI, 43 (16%) developed Stage 2 AKI, and 29 (11%) developed Stage 3 AKI. Risk factors prior to first episode of AKI stage 1 or higher included vancomycin use (HR=1.63; 95% CI 1.03-2.58), bilirubin rise of 1 mg/dL (HR=1.13; 95% CI 1.02-1.26), and cyclosporine level increase by 100 mg/dL (HR=1.23; 95% CI 1.13-1.34). Male gender and acute GVHD grade 2-4 were protective. Stage 2-3 and stage 3 AKI were associated with non-relapse mortality at 1 year (HR=3.26; 95%CI 1.65-6.45 and 42.41; 95%CI 16.18-111.18) respectively.
Conclusion
UCT recipients have a high frequency of stage 2 and 3 AKI. Risk factors for AKI appear to be different in the UCT population and further study is warranted to understand these differences.
Table 1. Multivariable cox regression models for more severe AKI and non-relapse mortality.
| Variable | Hazard Ratio | 95% Confidence interval | p-value |
| Age | 1.03 | 1.01-1.04 | 0.0001 |
| Gender | |||
| Female | Reference | ||
| Male | 1.43 | 0.86-2.38 | 0.17 |
| AKI Stage 2,3 (vs. 0,1) | |||
| No | Reference | ||
| Yes | 3.26 | 1.65-6.45 | 0.001 |
| AKI Stage 3 (vs. 0,1,2) | |||
| No | Reference | ||
| Yes | 42.41 | 16.18-111.18 | <0.0001 |
Model adjusted for age, gender, CMV status, and disease severity