Clinical Analysis Of Early Acute Kidney Injury After Hematopoietic Stem Cell Transplantation In Patients With Malignant Hematological Diseases

Objective : To investigate the clinical characteristics,risk factors and prognosis of acute kidney injury(AKI)after transplantation in patients with hematopoietic stem cell transplantation(HSCT).Methods:Malignant blood disease patients received HSCT from August 2012 to March 2018 were collected and retrospectively analyzed.To describe the clinical characteristics of AKI within 100 days after hematopoietic stem cell transplantation,and to analyze the incidence of AKI,including incidence,median time,AKI stage and one-year overall survival.Gender,age,donor relevance,Human leukocyte antigen(HLA)and blood group matching,whether TBI is used in preconditioning regimen,Cyclosporin A(CSA)is used in GVHD regimen,amphotericin B,and posttransplant complications,such as Acute graft versus host disease,veno-occlusive disease(VOD),Hemorrhagic cystitis(HC),Thrombotic microvascular disease(TMA),secondary hypertension,and infection were included in the study to analyze the risk factors and prognosis of acute kidney injury after hematopoietic stem cell transplantation.Results:1.A total of 144 cases were included,66 males and 78 females.The median age was 33.85(8.49-62.09)years old and the average body weight was 56.21 kg.According to the 2012 Global Diagnostic Data of Kidney Diseases(KDIGO),the incidence of AKI was 29.2%(42/144)within 100 days after HSCT,and the median time was 32.5(3.0-97.0)days.There were 102 cases without renal injury and 42 cases with renal injury,including 11 cases of stage I renal injury,16 cases of stage II,and 15 cases of stage III.2.Univariate analysis showed that donor-related,HLA and blood group compatibility,acute graft-versus-host disease,infection(bacteria and/or fungi,cytomegalovirus)were associated with AKI after hematopoietic stem cell transplantation.Multivariate analysis suggested that HLA compatibility,acute graft-versus-host disease,and infection(bacteria and/or fungi)were independent risk factors for AKI.3.Follow-up up to 1 year after HSCT,45 of the 144 patients with malignant hematological diseases died,with an overall survival rate of 68.8%(99/144).Among them,25 patients without AKI had an overall survival rate of 75.5%(77/102).In the AKI group,the 1-year overall survival rate was 52.4%(22/42),and the number of AKI stage I~III deaths was 6(54.5%,6/11),8(50%,8/16),and 6(40%,6/15),respectively.Univariate analysis showed that early AKI after HSCT had an impact on the 1-year overall survival rate of patients(P < 0.05).Conclusion:Acute kidney injury is one of the common complications after hematopoietic stem cell transplantation for hematologic malignancies.HLA-matching degree,acute graft-versus-host disease and infection were independent risk factors for acute kidney injury after hematopoietic stem cell transplantation.AKI can affect the prognosis of patients after hematopoietic stem cell transplantation,actively control and manage its related risk factors,may reduce the incidence of AKI,and improve the prognosis of transplant patients.