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Chronic kidney disease, thrombotic microangiopathy, and hypertension following T cell-depleted hematopoietic stem cell transplantation.

Abstract
Chronic kidney disease (CKD) is now an accepted long-term complication of allogeneic hematopoietic stem cell transplantation. Calcineurin inhibitors (CNI), which are used for prophylaxis and treatment of graft-versus-host disease (GVHD), have been associated with the development of nephrotoxicity. Hypertension (HTN) and thrombotic microangiopathy (TMA) are 2 comorbidities linked to CKD. T cell depletion (TCD) of stem cell grafts can obviate the need for the use of CNI. We conducted a retrospective analysis of 100 patients who underwent TCD transplantation: 30 in group A were conditioned without total-body radiation (TBI) and 70 in group B received a TBI containing regimen. None of the patients received CNI. The median age was 55.5 and 45 years for groups A and B, respectively. Eleven patients developed TMA, all in group B. The 2-year cumulative incidence of sustained CKD was 29.2% and 48.8% in group A and group B, respectively, with a mean follow-up of at least 21 months. CKD free survival was better in the non-TBI group (P = .046). Multivariable survival analysis revealed that exposure to TBI, older age, and TMA were risk factors for CKD. The incidence of new onset or worsening HTN was 6.7% and 25.7% (P = .03) in group A and B, respectively. The use of TBI (P = .0182) and diagnosis of TMA (P = .0006) predisposed patients to the development of HTN using univariable logistic regression models. Thus, despite the absence of CNI, a proportion of these older patients in both groups developed CKD and HTN.
AuthorsIlya G Glezerman, Kenar D Jhaveri, Thomas H Watson, Alison M Edwards, Esperanza B Papadopoulos, James W Young, Carlos D Flombaum, Ann A Jakubowski
JournalBiology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 16 Issue 7 Pg. 976-84 (Jul 2010) ISSN: 1523-6536 [Electronic] United States
PMID20153836 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
Topics
  • Disease-Free Survival
  • Female
  • Hematopoietic Stem Cell Transplantation (adverse effects, methods)
  • Humans
  • Hypertension (etiology)
  • Kidney Failure, Chronic (etiology)
  • Male
  • Middle Aged
  • Retrospective Studies
  • Survivors
  • T-Lymphocytes (immunology)
  • Thrombotic Microangiopathies (etiology)
  • Transplantation, Homologous

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