Acute renal failure following nonmyeloablative hematopoietic cell transplantation

Acute renal failure (ARF) is a common life threatening complication following conventional myeloablative allogeneic hematopoietic stem cell transplant (HCT), previously termed bone marrow transplant. In our previous study, the incidence of clinically significant ARF was 69% in the setting of allogeneic HCT. The study also demonstrated that in patients with allogeneic HCT, the trend of mortality increased with worsening renal failure. The overall mortality was 58% at 6 months in this study.; Non-myeloablative HCT is a recently developed alternative to conventional myeloablative allogeneic HCT. Non-myeloablative HCT is better tolerated than traditional allogeneic HCT because of lower-intensity conditioning therapy used before transplantation. The goal of this study was to evaluate ARF in a large group of patients who received non-myeloablative HCT and to determine its associated risk factors and outcomes. This retrospective cohort study accessed the multi-center population of patients undergoing non-myeloablative HCT at four major university centers from 1998 to 2001. All of the patients were treated on multi-institution shared protocols. ARF was classified into four grades.; Clinically significant ARF occurred in 40.4% of patients over a period of 3 months following non-myeloablative HCT. The overall mortality was 34% at 1 year following. Need for artificial ventilation was independently associated with development of clinically significant ARF in our multivariate analysis [OR 10.4 CI (3.7–28.5)]. Surviving patients with non-myeloablative HCT had a significant decrease (mean reduction of GFR 24 ml/min/m2) in their renal function within 1 year. The mortality increased with worsening grade of ARF and dialysis was an independent predictor of mortality at 1 year [OR 5.78 CI (1.4–24.1)]. Although non-myeloablative HCT is a predominantly outpatient procedure, distance traveled by patients was not related to outcomes like ARF and death.; The risk of developing ARF with non-myeloablative allogenic HCT is lower than conventional myeloablative allogeneic HCT. ARF contributes to overall mortality and thus impacts overall outcomes with non-myeloablative allogenic HCT. The combined need for dialysis and artificial ventilation following non-myeloablative HCT portends a very poor prognosis. Future studies are needed to evaluate potential interventions to decrease the incidence and severity of ARF in the setting of HCT.