Impact of pre-transplant renal dysfunction on outcomes after allogeneic hematopoietic cell transplantation

ABSTRACT Introduction : Renal dysfunction is a recognized risk factor for mortality after allogeneic hematopoietic cell transplantation (alloHCT). Yet, understanding of the effect of different levels of renal dysfunction at time of transplant on outcomes remains limited. This study explores the impact of different degrees of renal dysfunction on HCT outcomes and examines whether utilization of incremental degrees of renal dysfunction based on estimated glomerular filtration rate (eGFR) improve the predictability of the hematopoietic cell transplantation- comorbidity index (HCT-CI). Methods : Study population included two cohorts: cohort 1 with patients age 40 years and older who received alloHCT for treatment of hematologic malignancies from 2008 to 2016 (N=13,505; cohort selected given very low incidence of renal dysfunction in Results : eGFR Conclusion : The degree of pre-transplant renal dysfunction is an independent predictor of OS, NRM, and probability of needing dialysis after alloHCT. An eGFR-based HCT-CI is a validated index in predicting outcomes in adults with hematologic malignancies undergoing alloHCT. The outcomes of alloHCT recipients on dialysis are dismal. Therefore, one should strongly weigh the significant risks of being on HD as a factor in determining alloHCT candidacy.