Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Feb;39(2):397-408.
doi: 10.1007/s00467-023-05964-4. Epub 2023 Apr 20.

Risk factors for acute kidney injury in pediatric patients after hematopoietic stem cell transplantation: a systematic review and meta-analysis

Baoyi Huang  1 , Jiayi Shan  1 , Lichen Yi  1 , Yijun Xin  1 , Zhishan Zhong  1 , Hua Xu  2
Affiliations
Meta-Analysis

Risk factors for acute kidney injury in pediatric patients after hematopoietic stem cell transplantation: a systematic review and meta-analysis

Baoyi Huang et al. Pediatr Nephrol. 2024 Feb.

Abstract

Background: Risk factors for acute kidney injury (AKI) in pediatric patients after hematopoietic stem cell transplantation (HSCT) remain controversial.

Objectives: This study aimed to identify risk factors for AKI following HSCT in the pediatric population.

Data sources: PubMed, Embase, Web of Science, Cochrane Library, and Scopus databases were searched from inception to February 8, 2023.

Study eligibility criteria: Studies meeting the following criteria were included: (1) The study was a case-control, cohort study, or cross-sectional design, (2) the study was performed among pediatric and young patients aged 21 years or younger undergoing HSCT, (3) the study measured at least one related factor for AKI after pediatric HSCT, (4) the study included a sample of at least ten patients, and (5) original articles published in English in peer-reviewed scientific journals.

Participants and interventions: Children who were undergoing pediatric HSCT.

Study appraisal and synthesis methods: We assessed the quality of the included studies and analyzed them with a random-effect model.

Results: Fifteen studies with a total of 2,093 patients were included. All were cohort studies of high quality. The overall pooled incidence of AKI was 47.4% (95%CI 0.35, 0.60). We found significant associations between post-transplant AKI in pediatric patients and unrelated donor [odds ratio (OR) = 1.74, 95% confidence interval (CI) 1.09-2.79], cord blood stem cell transplantation (OR = 3.14, 95%CI 2.14-4.60), and veno-occlusive disease (VOD)/sinusoidal obstruction syndrome (SOS) (OR = 6.02, 95%CI 1.40-25.88). Other controversial factors such as myeloablative conditioning (MAC), acute graft vs. host disease (aGVHD), and the use of calcineurin inhibitors (CNI) were not found to be related to AKI after pediatric HSCT.

Limitations: Results were limited mainly by heterogeneity in the characteristics of patients and transplantation.

Conclusions and implications of key findings: Posttransplant AKI in children is a common complication. Unrelated donors, cord blood stem cell transplantation, and VOD/SOS might be risk factors for AKI after pediatric HSCT. Further large-scale studies are still needed to draw firm conclusions.

Systematic review registration number: CRD42022382361 A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Acute kidney injury; Hematopoietic stem cell transplantation; Pediatrics; Risk factors.

PubMed Disclaimer

References

    1. Raina R, Abu-Arja R, Sethi S, Dua R, Chakraborty R, Dibb JT, Basu RK, Bissler J, Felix MB, Brophy P, Bunchman T, Alhasan K, Haffner D, Kim YH, Licht C, McCulloch M, Menon S, Onder AM, Khooblall P et al (2022) Acute kidney injury in pediatric hematopoietic cell transplantation: critical appraisal and consensus. Pediatr Nephrol 37:1179–1203. https://doi.org/10.1007/s00467-022-05448-x - DOI - PubMed
    1. Askenazi DJ, Feig DI, Graham NM, Hui-Stickle S, Goldstein SL (2006) 3-5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int 69:184–189. https://doi.org/10.1038/sj.ki.5000032 - DOI - PubMed
    1. Mammen C, Al Abbas A, Skippen P, Nadel H, Levine D, Collet JP, Matsell DG (2012) Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis 59:523–530. https://doi.org/10.1053/j.ajkd.2011.10.048 - DOI - PubMed
    1. Sutherland SM, Byrnes JJ, Kothari M, Longhurst CA, Dutta S, Garcia P, Goldstein SL (2015) AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol 10:554–561. https://doi.org/10.2215/cjn.01900214 - DOI - PubMed - PMC
    1. Benoit SW, Dixon BP, Goldstein SL, Bennett MR, Lane A, Lounder DT, Rotz SJ, Gloude NJ, Lake KE, Litts B, Davies SM (2019) A novel strategy for identifying early acute kidney injury in pediatric hematopoietic stem cell transplantation. Bone Marrow Transplant 54:1453–1461. https://doi.org/10.1038/s41409-018-0428-6 - DOI - PubMed

LinkOut - more resources