Acute renal failure after nonmyeloablative stem cell transplantation in adults

Abstract

Acute renal failure (ARF) after myeloablative stem cell transplantation (SCT) is a well-established problem. Little is known about ARF after nonmyeloablative SCT. The aim of the present study was to assess the incidence of ARF and to analyze risk factors for ARF. Moreover, we wanted to study whether ARF influenced survival. We performed a retrospective cohort study of 150 adults who received nonmyeloablative SCT (fludarabine 30 mg/m(2)/day for 3 days and/or total-body irradiation (TBI) 200 cGy). ARF was categorized into grade 0 (no ARF), grade 1 (decrease in glomerular filtration rate >or=25% and <or= doubling in serum creatinine), grade 2 (> doubling in serum creatinine), and grade 2 plus (> tripling in serum creatinine). ARF grade 2-2 plus developed in 49 of 150 patients (33%) after a median of 37 days, 14 patients (9%) had ARF grade 2 plus. No patient required dialysis. Risk factors at baseline for ARF grade 2-2 plus were a history of autologous transplantation (P = .008), the absence of vascular disease (P = .012) lower serum creatinine (P < .001), and higher glomerular filtration rate (P < .001). Acute graft-versus-host disease (aGVHD) grade III-IV was the only complication that was associated with ARF (P = .035). Overall mortality at 1 year was 23%. Patients with ARF grade 2-2 plus had significantly higher mortality compared to ARF grade 0-1 (P = .006). This was largely attributable to a diminished survival in patients with ARF grade 2 plus, who had a mortality rate of 71% caused by, among others, progression of malignancy and GVHD. This makes severe ARF an indicator for decreased survival.