Work

Kidney Dysfunction Post-Allogeneic Transplant: High Incidence of TMA and Kidney GvHD

Year: 2018

Type: article

Abstract: Introduction: Kidney dysfunction is an important problem in adult recipients of allogeneic stem cell transplantation (HSCT), occurring in ~50% of transplant recipients, and independently predicts overall survival and non-relapse mortality. More than 20% of all survivors develop chronic kidney disease on long-term follow-up. However, there is currently limited data on its causes and consequences. Kidney biopsies are seldom obtained, thus without tissue, the diagnosis often remains speculative. Early identification of the causes of kidney dysfunction may help define preventive and therapeutic strategies and improve outcome. We designed a prospective study at our center to systematically evaluate kidney dysfunction post-HSCT. Here we present our initial findings. Methods: All adult HSCT recipients with kidney dysfunction were evaluated by Nephrologists to determine the need for kidney biopsy. Kidney dysfunction was defined as either (i) acute kidney failure or (ii) proteinuria. Acute kidney failure was defined by the, “Kidney Disease: Improving Global Outcomes (KDIGO)”, criteria. Proteinuria was defined as (i) spot urine albumin to creatinine ratio of ≥1 (equivalent to ≥1 g in 24 hours). Kidney biopsies were done under ultrasound guidance and the tissue specimens were interrogated by light, immunofluorescence and electron microscopy. Results:A total of 8 HSCT recipients (including one patient who had a biopsy prior to Aug 2016) underwent kidney biopsies. The patient and transplant characteristics are summarized in Table 1.Table 1 Median time to neutrophil engraftment was 13.5 days (range 9-20). Median time to platelet engraftment was 19 days (range 14-76). There were no cases of graft failure. All patients also demonstrated either acute or chronic GVHD of other organs—most commonly skin. All kidney biopsies were performed without complications. Kidney biopsies were done at median 254 days after transplantation (range 126-680). Baseline serum creatinine (mg/dL) prior to transplant was .95 (median, range .65-1.1, reference range: .64-1.27 mg/dL). Creatinine at time of biopsy: 3.0 (median, range 1.53-5.07). Urine albumin/creatinine ratio: 832 (median, range 55-2864, reference range: < 30). The kidney biopsy findings are summarized in Table 2.Table 2 The clinical outcomes are summarized in Table 3.Table 3

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2017.12.779