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Evidence of Stem Cell Entrapment in AN69 Membranes During Continuous Renal Replacement Therapy

Year: 2025

Type: article

Abstract: BACKGROUND: Continuous renal replacement therapy (CRRT) is increasingly employed in pediatric intensive care units (PICUs) for managing both renal and non-renal conditions, including sepsis through cytokine removal. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a critical treatment for inherited bone marrow syndromes but poses challenges when performed alongside extracorporeal therapies like CRRT. This case explores the interaction between hematopoietic stem cells and AN69 membranes during CRRT in a pediatric patient undergoing allo-HSCT amid septic shock. METHODS: A 10-year-old boy with bone marrow failure of unknown etiology and chronic kidney disease underwent allo-HSCT from a fully matched sibling donor. The patient developed septic shock following a reduced-intensity conditioning regimen and was managed with continuous venovenous hemodiafiltration using an AN69 membrane. During the allo-HSCT infusion, the CRRT membrane became clogged, prompting immunohistochemical analysis of the AN69 membrane to investigate potential HSC entrapment. CD34-positive cells and fibronectin expression on the membrane were assessed using staining protocols. RESULTS: Despite severe septic shock and potential HSC entrapment in the AN69 membrane, the patient achieved full donor chimerism with 97% hematopoietic engraftment by day nineteen post-HSCT. Immunohistochemical analysis revealed the presence of CD34-positive HSCs and strong fibronectin staining on the clogged AN69 membrane, indicating significant interaction and entrapment of stem cells. CONCLUSION: Allo-HSCT can be performed successfully in pediatric patients with severe septic shock requiring CRRT, offering a potentially life-saving option in urgent transplant situations. This case highlights that although HSPCs can be entrapped on AN69 membranes, engraftment was not compromised. Our findings provide novel insights into HSPC interactions with AN69 membranes during CRRT, and further studies are needed to quantify stem cell loss and explore its clinical implications.

Source: Artificial Organs

DOI: 10.1111/aor.15004

Authors: Izzet Turkalp Akbasli, Ozlem Saritas Nakib, Selman Kesici, Fatma Visal Okur, Kadri Safak Gucer, Benan Bayrakci

Institutions: Cleveland Clinic, Hacettepe University, Birmingham Children's Hospital

Language: English

Topic: Hematopoietic Stem Cell Transplantation

Subfield: Hematology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

Funders: Gazi Üniversitesi, Hacettepe Üniversitesi