ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: TH-PO523

Severe AKI and CKD Are Common in Children with Veno-Occlusive Disease Following Bone Marrow Transplantation

Session Information

  • Pediatric Nephrology - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Culley, Kylie, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Rahrig, April, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Rowan, Courtney M., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Skiles, Jodi L., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Hains, David S., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Starr, Michelle C., Indiana University School of Medicine, Indianapolis, Indiana, United States
Background

Veno-occlusive disease (VOD) is a life-threatening complication occuring after bone marrow transplantation (BMT). The prevalence and severity of short and intermediate kidney outcomes is unknown.

Methods

Single center retrospective cohort of children with VOD following BMT from 2010-2020 (N=44). Primary outcome was treatment with kidney replacement therapy (KRT). Secondary outcomes included severe AKI and CKD at 1 year post BMT.

Results

Severe AKI developed in 35 (80%) of children with VOD and KRT was used in 21 (48%). Childen receiving KRT were younger (p=.041) and had lower pre-BMT eGFR (p=.032). Children receiving tacrolimus for GVHD prophylaxis (p<.001), shorter time to VOD diagnosis (p=.021), and more fluid overload (p=.001) were more likely to require KRT (Table). 33 (75%) survived to discharge. Of those receiving KRT, 13 (62%) survived to discharge. One year following BMT, 19 patients (43%) had died. Of those alive at 1 year, 9 (36%) had CKD and 9 (36%) had hypertension (Figure).

Conclusion

Despite high mortality, severe AKI and KRT in children with VOD is no longer universally fatal. In those that survive, CKD is common. We describe patient and treatment factors associated with KRT. Further study is needed to assess the causality, such as fluid overload and target interventions, such as diuretic therapy and individualized fluid management, in this high-risk patient population.

Table: Clinical Characteristics of Children with VOD by Kidney Replacement Therapy (KRT) status

Figure: Chronic Kidney Disease in Children with VOD following BMT