Acute kidney injury in critically ill allo-HSCT recipients

摘要

We read with great interest the study by Benz et al. on risk factors and outcomes of patients admitted to the intensive care unit (ICU) after allogeneic hematopoietic SCT (allo-HSCT). They found that acute GVHD and HLA mismatch were associated with ICU admission. They also reported poor outcomes after ICU admission (case fatality rate 64%), mostly related to the extent of organ dysfunction. On the basis of our experience, we would like to draw attention to the clinical relevance of acute kidney injury (AKI) in allo-HSCT recipients, a feature not addressed by Benz et al. Indeed, allo-HSCT recipients are known to be at high risk for AKI as they often are exposed to combinations of various nonspecific insults (sepsis, nephrotoxic drugs, contrast agents, dehydration, kidney infiltration by the malignancy, anemia). In addition, they can develop specific causes of AKI over time such as tumor lysis syndrome, engraftment syndrome, veno-occlusive disease (VOD) and thrombotic microangiopathy (TMA).