Acute Renal Failure Following Myeloablative Autologous and Allogeneic Haematopoietic Cell Transplantation.

Acute Renal Failure (ARF) is a common complication in the early period of myeloablative autologous and allogeneic haematopoietic cell transplantation (HCT). Reported incidence varies from 30% to 80%. This study evaluates retrospectively the incidence of ARF, defined as the doubling of serum creatinine within the first 100 days after HCT, associated risk factors, the need of dialytic therapy as well as mortality of HCT patients who received a myeloablative autologous or allogeneic HCT in our Hospital between January 2003 and December 2004. One-hundred and forty patients (86 men, mean age: 32,9±14,69 years) were studied: 90 patients (53 men, mean age: 33,6±13,73 years) had an allogeneic HCT and 50 (33 men, mean-age: 31,71±16,25 years) an autologous HCT; 82 patients (51 men, mean age: 33,17±14,1 years) received a peripheral blood stem cell (PBSC) transplantation and 58 (35 men, mean age: 32,51±15,61 years) a bone marrow (BM) graft. The incidence of ARF was 21,5% (30/140) (16 men, mean age: 31,53±13,21 years) but did not reach a statistically significant difference between patients who received an allogeneic or autologous HCT (27% vs 12%, p=0.07) or were transplanted with BM graft or PBSC (10% vs 17%, p=ns). Nephrotoxicity (n=20), septic shock (n=16), graft vs host disease (n=6) and veno-occlusive disease (n=3) were the most common etiologies associated with ARF. The incidence of dialysis-dependent ARF was 30% (9/30) and was higher in patients with a BM graft (50% vs 7%, p<0.03) but did not differ in patients who received an allogeneic or autologous HCT (33% vs 16%, p=0.08); 4 patients were treated with intermittent hemodialysis and 5 with continuous dialytic therapy (continuous veno-venous hemodiafiltration). Among patients who received only medical therapy (n=21), 11 had complete renal function recovery (RFR) and 2 had partial RFR. Overall mortality rate was 16,4% (23/140) and was higher in patients with ARF (57% vs 6%, p=0.0001), particularly if there was a need of dialysis therapy (100% vs 38%, p=0.006).

This study shows that ARF is prevalent during the early period of HCT and increases mortality, particularly if it is dialysis-dependent. However, in our cohort of patients the incidence of ARF was lower than the previously described in other studies. Low occurrence of veno-occlusive disease could explain this phenomenon, which may be related to adequate prophylactic measures.