Hyperferritinemia and acute kidney injury in pediatric patients receiving allogeneic hematopoietic cell transplantation
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ORIGINAL ARTICLE
Hyperferritinemia and acute kidney injury in pediatric patients receiving allogeneic hematopoietic cell transplantation Mari Kurokawa 1 & Kei Nishiyama 1 & Yuhki Koga 1 & Katsuhide Eguchi 1 & Takashi Imai 1 & Utako Oba 1 & Akira Shiraishi 1 & Hazumu Nagata 1 & Noriyuki Kaku 1,2 & Masataka Ishimura 1 & Satoshi Honjo 3 & Shouichi Ohga 1 Received: 24 December 2019 / Revised: 15 April 2020 / Accepted: 15 May 2020 # IPNA 2020
Abstract Background Acute kidney injury (AKI) often occurs in pediatric patients who received allogeneic hematopoietic cell transplantation (HCT). We evaluated the risk and effect of HCT-related AKI in pediatric patients. Methods We retrospectively studied the survival and renal outcome of 69 children 100 days and 1-year posttransplant in our institution in 2004–2016. Stage-3 AKI developed in 34 patients (49%) until 100 days posttransplant. Results The 100-day overall survival (OS) rates of patients with stage-3 AKI were lower than those without it (76.5% vs. 94.3%, P = 0.035). The 1-year OS rates did not differ markedly between 21 post-100-day survivors with stage-3 AKI and 29 without it (80.8% vs. 87.9%, P = 0.444). The causes of 19 deaths included the relapse of underlying disease or graft failure (n = 11), treatment-related events (4), and second HCT-related events (4). Underlying disease of malignancy (crude hazard ratio (HR) 5.7; 95% confidence interval (CI), 2.20 to 14.96), > 1000 ng/mL ferritinemia (crude HR 4.29; 95% CI, 2.11 to 8.71), stem cell source of peripheral (crude HR 2.96; 95% CI, 1.22 to 7.20) or cord blood (crude HR 2.29; 95% CI, 1.03 to 5.06), and myeloablative regimen (crude HR 2.56; 95% CI, 1.24 to 5.26), were identified as risk factors for stage-3 AKI until 100 days posttransplant. Hyperferritinemia alone was significant (adjusted HR 5.52; 95% CI, 2.21 to 13.76) on multivariable analyses. Conclusions Hyperferritinemia was associated with stage-3 AKI and early mortality posttransplant. Pretransplant iron control may protect the kidney of pediatric HCT survivors. Keywords Hyperferritinemia . Acute kidney injury . Allogeneic hematopoietic cell transplantation . Pediatric hematopoietic cell transplantation
Abbreviations AKI Acute kidney injury HCT Hematopoietic cell transplantation OS Overall survival Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00467-020-04619-y) contains supplementary material, which is available to authorized users.
HR CI HLA TBI VOD GVHD CMV SOS
Hazard ratio Confidence interval Human leukocyte antigen Total body irradiation Veno-occlusive disease Graft-versus-host disease Cytomegalovirus Sinusoidal obstruction syndrome
* Yuhki Koga [email protected]
Introduction 1
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
2
Pediatric Intensive Care Unit, Kyushu University Hospital, Fukuoka, Japan
3
Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka,
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