The Development of Acute Kidney Disease Following Allogeneic Hematopoietic Stem Cell Transplantation

INTRODUCTION: Acute kidney disease is an important complication of allogeneic hematopoietic stem cell transplantation. The aim of this retrospective study was to identify major risk factors for acute kidney disease in hematopoietic stem cell transplantation and its effect on patients survival.
METHODS: This study was a retrospective review of 77 patients with allogeneic hematopoietic stem cell transplantation at our department from January 2007 to October 2015.
RESULTS: Acute kidney disease developed in 25 of 77 patients (32.5%). The median time to development of acute kidney disease after transplantation was 30 days. Univariate analysis showed that baseline serum gamma-glutamyl transpeptidase level, amphotericin B use and cyclosporine level were associated with the development of acute kidney disease. Logistic regression multivariate analysis showed that amphotericin B use, cytomegalovirus reactivation, conditioning regimen and cyclosporine level were an independent risk factor for acute kidney disease. Mortality and non-relapse mortality rates were higher in patients with acute kidney disease than in those without acute kidney disease. In Kaplan-Meier analysis, median survival was 18.4 months in patients without acute kidney disease and 12.2 months in patients with acute kidney disease.
DISCUSSION AND CONCLUSION: Acute kidney disease has a poor prognosis in hematopoietic stem cell transplantation and conditioning regimen, cytomegalovirus reactivation, amphotericin B use and particularly cyclosporine level are independent risk factors in the development of acute kidney disease in hematopoietic stem cell transplantation recipients.

Allojenik Hematopoetik Kök Hücre Nakli Sonrasý Akut Böbrek Hastalýðý Geliþimi

GÝRÝÞ ve AMAÇ: Akut böbrek hastalýðý, allojenik hematopoetik kök hücre naklinin önemli komplikasyonlarýndan biridir. Bu çalýþmada hematopoetik kök hücre naklinde akut böbrek hastalýðý için major risk faktörlerini ve bunun hastalarýn yaþam süresi üzerine olan etkisini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Bu çalýþmada kliniðimizde Ocak 2007 ile Ekim 2015 yýllarý arasýnda allojenik hematopoetik kök hücre nakli olan 77 hastayý retrospektif olarak deðerlendirdik.
BULGULAR: Çalýþmaya alýnan 77 hastanýn 25’inde (%32.5) akut böbrek hastalýðý geliþti. Transplantasyondan sonra akut böbrek hastalýðýnýn ortalama geliþme süresi 30 gündü. Univariate analizde bazal serum gamma-glutamil transpeptidaz düzeyi, amfoterisin B kullanýmý ve özellikle siklosporin düzeyinin akut böbrek hastalýðý geliþme riski ile iliþkili olduðu gösterildi. Lojistik regresyon multivariate analizde amfoterisin B kullanýmý, sitomegalovirüs reaktivasyonu, hazýrlama rejimi ve siklosporin düzeyinin akut böbrek hastalýðý için baðýmsýz risk faktörleri olduðu tespit edildi. Mortalite ve non-relaps mortalite oranlarý akut böbrek hastalýðý olan hastalarda, akut böbrek hastalýðý olmayan hastalara göre daha yüksekti. Kaplan-Meier analizde, ortalama yaþam süresi akut böbrek hastalýðý olmayan hastalarda 18.4 ay iken, akut böbrek hastalýðý olan hastalarda 12.2 aydý.
TARTIÞMA ve SONUÇ: Akut böbrek hastalýðý, hematopoetik kök hücre naklinde kötü prognoza sahiptir ve hazýrlama rejimi, sitomegalovirüs reaktivasyonu, amfoterisin B kullanýmý ve özellikle siklosporin düzeyi hematopoetik kök hücre nakil alýcýlarýnda akut böbrek hastalýðý geliþmesi için baðýmsýz risk faktörü olarak göz önünde bulundurulmalýdýr.