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Abstract: FR-OR09

Vancomycin-Tacrolimus Combination Increases AKI Risk in Post-Hematopoietic Stem Cell Transplantation (HSCT) Patients

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Gupta, Tuisha, Tbilisi State Medical University, Tbilisi, Tbilisi , Georgia
  • Liu, Yuan, Emory University, Atlanta, Georgia, United States
  • Hall, Kevin, Emory University, Atlanta, Georgia, United States
  • Surati, Minal J., Emory University, Atlanta, Georgia, United States
  • Waller, Edmund K., Emory University, Atlanta, Georgia, United States
Background

Acute kidney injury (AKI) is a common complication in hematopoietic stem cell transplant (HSCT) recipients, leading to prolonged hospital stays, increased healthcare costs and mortality rates. Drug-related effects are major contributors of AKI in this patient population. Immunosuppressive and antibacterial drugs, such as vancomycin and tacrolimus, have well-documented nephrotoxic effects. Combinations of tacrolimus and vancomycin with other drugs are known to induce AKI. However, the combined nephrotoxic effect of vancomycin and tacrolimus warrants further investigation. This study aims to evaluate their simultaneous nephrotoxic effects in HSCT patients.

Methods

Institutional Review Board approval was obtained for retrospective analysis of transplant outcomes. This retrospective cohort study includes 1444 HSCT patients (age>18) from 2018-2021 at Emory University Hospital. Patients with end-stage renal disease were excluded from the study. The KDIGO guidelines: increase in serum creatinine levels ≥0.3 mg/dL within 48 hours or ≥50% within 7 days, were used to define AKI in the study population. Data was collected from day 0 to day +30 post-HSCT by reviewing in and out-patient medical records. Univariate and multivariable logistic regression was used to estimate the interaction effect between vancomycin and tacrolimus.

Results

The median patient age was 61, with 55% males, 58% white/35% black. Of the total patients, 51% had hypertension, 14% diabetes mellitus, 15% CKD, 8% congestive heart failure (CHF). The overall AKI incidence was 9.94%, with 19.81% among allogeneic transplant recipients and 7.24% among autologous transplant recipients (OR 3.28 p<0.001). Other AKI associated covariates were male gender (OR 1.59 p 0.022), CHF history (OR 2.26, p 0.006), high BMI (OR 1.06, p<0.001) and low creatinine clearance (OR 0.96 p<0.001). Using multivariate logistic regression, the primary outcome measure, the incidence of AKI was significantly higher in patients receiving a combination of vancomycin and tacrolimus (OR 5.50 p<0.001) than patients receiving tacrolimus alone without vancomycin (OR 4.04 p<0.001).

Conclusion

Concurrent administration of vancomycin and tacrolimus greatly increases the risk of AKI compared to the individual drugs alone. Thus, the simultaneous use of these medications should be avoided or minimized with close monitoring in allo-HSCT recipients.