The Impact of Allogeneic Hematopoietic Stem Cell Transplantation on Kidney Function in Children—A Single Center Experience

Abstract

Background: Knowledge about the impact of allogeneic hematopoietic stem cell transplantation (alloHSCT) on renal function in children is still limited. Objectives: The aim of the study was to evaluate kidney function in children undergoing alloHSCT, with special focus on differences between patients transplanted due to oncological and non-oncological indications. Materials and Methods: The data of 135 children undergoing alloHSCT were analyzed retrospectively. The serum creatinine and estimated glomerular filtration rate (eGFR) values were estimated before transplantation at 24 h; 1, 2, 3, 4 and 8 weeks; and 3 and 6 months after alloHSCT. Then, acute kidney injury (AKI) incidence was assessed. Results: Oncological children presented with higher eGFR values and more frequent hyperfiltration rates than non-oncological children before alloHSCT and until the 4th week after transplantation. The eGFR levels rose significantly after alloHSCT, returned to pre-transplant records after 2–3 weeks, and decreased gradually until the 6th month. AKI incidence was comparable in oncological and non-oncological patients. Conclusions: Children undergoing alloHSCT due to oncological and non-oncological reasons demonstrate the same risk of AKI, but oncological patients may be more prone to sustained renal injury. Serum creatinine and eGFR seem to be insufficient tools to assess kidney function in the early post-alloHSCT period, when hyperfiltration prevails, yet they reveal significant differences in long-term observation.

Recent Advances of Acute Kidney Injury in Hematopoietic Cell Transplantation

“…Representative studies that focus on the association of AKI with transplant outcomes are shown in Table 2. In pediatric HCT recipient, the incidence of AKI is similar to adults (44,48,49,(56)(57)(58), AKI worsens mortality after HCT (49,57), and the 1-year survival rate is less than 10% in patients with renal failure requiring renal replacement therapy (56). Fortunately, HCT-related AKI has decreased in recent years due to the increased use of less toxic conditioning regimens, decreased rates of SOS, modified infection prophylaxis, less amphotericin B use, and declining rates of severe aGVHD (59,60).…”

“…Whether the indication for HCT is for a malignant or nonmalignant disorders does not significantly affect the incidence of AKI ( 33 , 48 , 49 ). However, malignancies are a risk factor for post-transplant CKD ( 50 ), and these patients should be monitored carefully for changes in renal function.…”

Current Concepts of Pediatric Acute Kidney Injury—Are We Ready to Translate Them into Everyday Practice?

“…One of the examples is the recently published data on renal function and AKI incidence in children undergoing hematopoietic stem cell transplantation (HSCT), who are classified by RAI as those at high risk of developing AKI. Most of the pediatric patients presented with hyperfiltration even before the procedure and its presence was correlated with previous chemotherapy [ 40 ]. Of note, the percentage of children with increased eGFR values was the highest among those who have undergone HSCT for oncological reasons.…”

The Onco-Nephrology Field: The Role of Personalized Chemotherapy to Prevent Kidney Damage

“…A recent and interesting retrospective study by Musiał et al [ 101 , 102 ] evaluated renal function in children undergoing allogenic-HSCT, analyzing the possible differences between patients transplanted for oncological causes compared to those transplanted for non-oncological causes. The authors concluded that children undergoing HSCT, both for oncological indications and for those non-oncological, have the same risk of developing AKI, as defined by Kidney Disease: Improving Global Outcome (KDIGO) [ 103 ] and pRIFLE criteria [ 104 ].…”