The Incidence, Risk Factors, and Outcomes of Acute Kidney Injury in Pediatric Hematopoietic Stem Cell Transplant Recipients.

Abstract

Introduction: Acute kidney injury (AKI) is a frequent complication after hematopoietic stem cell transplantation (HSCT), with reported incidences ranging from 20-70% within the first 100 days post-transplant. AKI can adversely impact outcomes and survival in this patient population.

Methods: This retrospective study evaluated 110 pediatric patients who underwent HSCT at Mofid Children's Hospital, affiliated with Shahid Beheshti University of Medical Sciences, Tehran, Iran, between 2016-2021. AKI was defined and staged according to the criteria for Kidney Disease Improving Global Outcomes (KDIGO).

Results: The cohort comprised 68 (61.8%) males and 42 (38.2%) females, with a mean age of 6.4 ± 4.1 years. Underlying disorders were malignant in 64 (58.1%) and non-malignant in 46 (41.9%) patients. Among the cohort, 84 (76.3%) patients underwent allogeneic HSCT, while 26 (23.7%) received autologous HSCT. Myeloablative and reduced-intensity conditioning regimens were used in 77 (70%) and 33 (30%) patients, respectively. AKI developed in 53 (48%) patients within 100 days post-transplant, with incidences of 38%, 40%, and 22% for stages 1, 2, and 3 AKI, respectively. AKI incidence was higher in allogeneic HSCT (52%) compared to autologous HSCT (17%; P = 0.023). Younger age (P = 0.033) and non-malignant disorders (P = 0.033) were associated with increased AKI risk. At the end of the study, 77 (70%) patients were alive, and 33 (30%) had deceased, with a significant positive correlation between AKI stage and mortality (P = 0.004).

Conclusion: This study highlights the high prevalence of AKI among pediatric HSCT recipients, particularly those undergoing allogeneic HSCT, at a younger age, and with non-malignant disorders. Regular post-transplant renal monitoring may improve survival in this population.