Research On Risk Factors Of Acute Kidney Injury After Hematopoietic Stem Cell Transplantation In Children

Objective:Hematopoietic stem cell transplantation(HSCT)is a treatment that involves the removal of tumor cells or other clonal cells from the recipient’s body by pretreatment with high-dose radiotherapy or other immunosuppressive agents to block the pathogenesis,followed by transplantation of autologous or allogeneic hematopoietic stem cells to the recipient to re-establish normal hematopoiesis and immunity.With the optimization of donor selection,improvement of pretreatment protocols,and enhancement of supportive therapies,the clinical application of HSCT has made great progress and has saved thousands of patients.However,complications that occur during transplantation often affect the prognosis,including sepsis,hepatic vein occlusion syndrome,hemorrhagic cystitis,graft-versus-host disease(GVHD),and others.Acute kidney injury(AKI)is a more common complication after HSCT,and the incidence of AKI after HSCT can reach 20%～73%.Many studies have shown that AKI decreases the overall survival of patients,especially when stage 3 AKI or renal failure occurs within 100 days after transplantation.The higher the severity of AKI,the higher the mortality rate of patients.The mortality rate can reach 80%in patients requiring renal replacement therapy.Therefore,this study aims to investigate the risk factors for AKI in post-transplant children by retrospectively analyzing the clinical data of children undergoing HSCT in our hospital,so that the results can be applied to clinical practice and minimize the occurrence of severe AKI after transplantation.Methods:The clinical data and survival data of 73 children who underwent HSCT in hospital were retrospectively analyzed to study the risk factors affecting AKI after HSCT.The data were compiled and then statistically analyzed using SPSS 23.0.To facilitate statistical analysis,quantitative information was expressed using specific values,and quantitative information was transformed into qualitative information according to the characteristics of the information.Qualitative data were expressed as number of cases,and the chi-square test was used for comparison between groups.The association of factors with AKI was analyzed using the chi-square test.Multifactor logistic regression analysis was used to screen out independent risk factors influencing the occurrence of AKI.Survival analysis was performed using KaplanMeier survival curves,and Log-Rank test was used to analyze whether there was a difference in the survival rate of different levels of AKI.The test level was set to P<0.05.Results:1.In summary of the general data,among the 73 children with HSCT,43(58.9%)were male and 30(41.1%)were female;the median age of the patients at transplantation was 8.8(1.4～14.0)years;there were 20(27.4%)patients with aplastic anemia,21(28.8%)patients with acute lymphoblastic leukemia,18 patients with acute myeloid leukemia(24.7%),4 patients with lymphoma(5.5%),6 patients with myelodysplastic syndrome(8.2%),and 4 patients with phagocytic syndrome(5.4%).42 patients(57.5%)had no renal injury(NAKI)after transplantation,15 patients(20.5%)had AKI stage Ⅰ,8 patients(11.0%)had AKI stage Ⅱ,and 8 patients(11.0%)had AKI stage Ⅲ.2.The differences of the proportions of age(≥9 years),≥3 nephrotoxic drugs,sepsis,GVHD(degree Ⅱ-Ⅳ),HVOD,transplant-associated thrombotic microangiopathy(TA-TMA)and iron overload before HSCT in the NAKI group,stage Ⅰ AKI group,stage Ⅱ AKI group,and stage Ⅲ AKI group were statistically significant(P<0.05).3.The results of association analysis showed that age(≥9 years),≥3 nephrotoxic drugs,sepsis,GVHD(degree Ⅱ-Ⅳ),HVOD,TA-TMA and iron overload before HSCT were associated with the occurrence of AKI(P<0.05).4.Multifactorial regression analysis of factors associated with AKI showed that>3 nephrotoxic drugs,sepsis,GVHD(degree Ⅱ-Ⅳ),HVOD and iron overload before HSCT were independent risk factors of AKI(P<0.05).5.The 1-year cumulative survival rate of children in the NAKI group,stage Ⅰ AKI group,stage Ⅱ AKI group,and stage Ⅲ AKI group were 83.3%,80%,75%and 37.5%.The survival rate of children in the stage Ⅲ AKI group was lower than that of the other groups(P<0.05).6.Among the independent risk factors of AKI,HVOD,GVHD(degree Ⅱ-Ⅳ)and iron overload before HSCT were associated with the occurrence of stage Ⅲ AKI(P<0.05).Conclusions:1.Age(≥9 years),≥3 nephrotoxic drugs,sepsis,GVHD(degree Ⅱ-Ⅳ),HVOD,TMA,and pre-transplant iron overload were correlated with the occurrence of posttransplant AKI.2.Nephrotoxic drugs>3,sepsis,GVHD(degree Ⅱ-Ⅳ),HVOD,and pretransplant iron overload were independent risk factors for post-transplant AKI.3.The occurrence of stage Ⅲ AKI after HSCT decreases the survival rate of the child.