High Incidence of Acute Kidney Injury after Cord Blood Transplant

Introduction Acute kidney injury (AKI) occurs frequently after hematopoietic cell transplant, affecting anywhere from 10-73% of patients and is associated with higher post-transplant mortality. In this retrospective study, we identified incidence and risk factors of AKI in cord blood transplant (CBT) recipients and evaluated the impact of AKI on non-relapse mortality (NRM) and overall survival (OS). Methods We focused on first CBTs performed for hematologic malignancies between 2006 and 2018. AKI was staged using the Kidney Disease Improving Global Outcomes (KDIGO) system (stages 1-3). We collected demographic data, transplant characteristics, and complications occurring within the first 60 days post-CBT. We identified risk factors for the development of AKI post-CBT and using Cox proportional hazards regression modeling, analyzed the association of AKI with both NRM and OS. Variables of clinical interest or those with a p-value Results 276 patients were evaluated. 227 (82%) suffered from acute leukemia. 243 (88%) patients received myeloablative conditioning regimen, 172 (62%) with high dose total body irradiation. 248 (90%) patients received cyclosporine as Graft versus Host-Disease (GvHD) prophylaxis. 186 (67%) patients developed AKI, with 114 (41%), 43 (16%) and 29 (11%) patients achieving a maximum of stage 1, stage 2 and stage 3 AKI, respectively. Cytomegalovirus (CMV), adenovirus and BK virus reactivation were detected in 126 (46%), 5 (2%) and 41 (15%) cases. 215 (78%) patients experienced grade 2-4 acute GvHD. In univariate analysis of time to first stage 2 AKI or higher, vancomycin use, bilirubin level, cyclosporin level and CMV viral load appeared to increase AKI risk, whereas male gender, grade 2-4 acute GvHD and systemic steroid use were found to be protective. BK virus reactivation had no significant effect on AKI risk. In MV analysis, only systemic steroid and bilirubin level remained significant (Table 1). Stage 2-3 AKI was associated with higher 1-year NRM [Hazard Ratio, HR 3.26, 95% CI (1.65-6.45), p=.001] and decreased OS [HR 2.28, 95% CI (1.22-4.27), p=.01]. Conclusions Our study confirms that stage 2-3 AKI is associated with an increased risk of NRM and overall mortality in CBT recipients. We found that the use of steroids was associated with lower risk of developing AKI. The protective effect exerted by steroids is of clinical interest and warrants further investigation.