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