Chronic Kidney Disease Thrombotic Microangiopathy and Hypertension Following T-cell Depleted Hematopoietic Stem Cell Transplantation

摘要

Chronic kidney disease (CKD) is now an accepted long term complication of allogeneic hematopoietic stem cell transplantation. Calcineurin inhibitors (CNI) which are used for prophylaxis and treatment of graft versus host disease have been associated with the development of nephrotoxicity. Hypertension (HTN) and thrombotic microangiopathy (TMA) are two comorbidities linked to CKD. T-cell depletion (TCD) of stem cell grafts can obviate the need for the use of CNI. We conducted a retrospective analysis of 100 patients who underwent TCD transplantation: 30 in group A were conditioned without total body radiation (TBI) and 70 in group B received a TBI containing regimen. None of the patients received CNI. The median age was 55.5 and 45 years for groups A and B respectively. Eleven patients developed TMA – all in group B. The two-year cumulative incidence of sustained CKD was 29.2 % and 48.8% in group A and group B respectively, with a mean follow up of at least 21 months. CKD free survival was better in non-TBI group (p=0.046). Multivariable survival analysis revealed that exposure to TBI, older age and TMA were risk factors for CKD. The incidence of new onset or worsening HTN was 6.7% and 25.7% (p=0.03) in group A and B, respectively. The use of TBI (p=0.0182) and diagnosis of TMA (p=0.0006) predisposed patients to the development of HTN using univariable logistic regression models. Thus, despite the absence of CNI, a proportion of these older patients in both groups developed CKD and HTN.