Incidence and risk factors for acute and chronic kidney injury after adult cord blood transplantation Journal Article
| Authors: | Gutgarts, V.; Jaffer Sathick, I.; Zheng, J.; Politikos, I.; Devlin, S. M.; Maloy, M. A.; Giralt, S. A.; Scordo, M.; Bhatt, V.; Glezerman, I.; Muthukumar, T.; Jaimes, E. A.; Barker, J. N. |
| Article Title: | Incidence and risk factors for acute and chronic kidney injury after adult cord blood transplantation |
| Abstract: | Although cord blood transplantation (CBT) extends allograft access, patient comorbidities, chemoradiation, and nephrotoxic medications all contribute to acute kidney injury (AKI) risk. We analyzed AKI in adult myeloablative CBT recipients who underwent transplantation from 2006 to 2017 for hematologic malignancies using cyclosporine A (CSA)/mycophenolate mofetil immunosuppression. Maximum grades of AKI were calculated using Kidney Disease: Improving Global Outcomes (grade 1, 1.5 to <2-fold; grade 2, 2 to <3-fold; or grade 3, ≥3-fold over baseline) definitions. In total, 153 patients (median 51 years [range, 23-65], 114/153 [75%] acute leukemia, 27/153 [18%] African, 88/153 [58%] cytomegalovirus seropositive, median age-adjusted hematopoietic cell comorbidity index 3 [range, 0-9], median pretransplant albumin 4.0 g/dL [range, 2.6-5.2]) underwent transplantation. The day 100 cumulative incidence of grade 1-3 AKI was 83% (95% confidence interval [CI], 77%-89%) (predominantly grade 2, median onset 40 days, range 0 to 96), and grade 2-3 AKI incidence was 54% (95% CI, 46%-62%) (median onset 43 days, range 0 to 96). Mean CSA level preceding AKI onset was high (360 ng/mL, target range 300-350). In multivariate analysis, African ancestry, addition of haploidentical CD34+ cells, low day –7 albumin, critical illness/intensive care admission, and nephrotoxic drug exposure (predominantly CSA and/or foscarnet) were associated with AKI. In a day 100 landmark analysis, 6% of patients with no prior AKI had chronic kidney disease (CKD) at 2 years versus 43% with prior grade 1 and 38% with prior grade 2-3 AKI (overall P=. 02). Adult CBT recipients are at significant AKI risk, and AKI is associated with increased risk of CKD. Prevention strategies, early recognition, and prompt intervention are critical to mitigate kidney injury. © 2020 American Society for Transplantation and Cellular Therapy |
| Keywords: | adult; middle aged; major clinical study; fludarabine; cd34 antigen; nephrotoxicity; cyclophosphamide; risk factor; thiotepa; intensive care; acute kidney failure; albumin; acute graft versus host disease; acute leukemia; cord blood stem cell transplantation; myeloablative conditioning; allogeneic hematopoietic stem cell transplantation; infection prevention; gram positive infection; vancomycin; immunosuppressive treatment; antibiotic prophylaxis; foscarnet; cytomegalovirus infection; cyclosporine; graft recipient; chronic kidney failure; drug exposure; african; cord blood transplantation; renal replacement therapy; mycophenolate mofetil; amphotericin; human; male; female; article; haploidentical transplantation; acute kidney impairment |
| Journal Title: | Biology of Blood and Marrow Transplantation |
| Volume: | 26 |
| Issue: | 4 |
| ISSN: | 1083-8791 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2020-04-01 |
| Start Page: | 758 |
| End Page: | 763 |
| Language: | English |
| DOI: | 10.1016/j.bbmt.2019.12.768 |
| PUBMED: | 31911259 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Muthukumar Thangamani's first and last names are reversed on the original publication -- Article -- Source: Scopus |
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