Background:
Allogeneic hematopoietic cell transplantation (hct), formerly called bone marrow transplantation, can potentially cure various malignant and non-malignant diseases, but it is associated with a high risk of toxicity. we have previously shown an overall 21% incidence of severe acute renal failure in patients undergoing autologous hct. the present study evaluated renal dysfunction in patients undergoing allogeneic hct.
Methods:
The clinical course of 88 adult patients who received allogeneic hct at the university of colorado health science center was analyzed. renal dysfunction was classified as follows: grade 0 = normal renal function; grade 1 =>25% decrement in gfr but twofold increase in serum creatinine; grade 3 =>twofold increase in serum creatinine and need for dialysis.
Results:
Of the 88 patients, 81 (92%) patients had some degree of renal dysfunction (grade 1, 20 patients; grade 2, 32 patients; grade 3, 29 patients). severe nephrotoxicity (grade 2 and grade 3 renal dysfunction) was associated with significantly higher frequencies of sepsis, hepatic toxicity and hepatic veno-occlusive disease (vod), and lung toxicity. the overall mortality rate at the end of 6 months was 58%. grade 3 renal dysfunction was associated with a significantly increased risk of mortality (82.6%).
Conclusion:
A 92% incidence of renal dysfunction in allogeneic hct patients was found. lung and liver toxicities were significantly correlated with developing renal dysfunction, and the mortality rates for patients with grade 3 renal failure exceeded 80%.