Renal Transplantation for End-Stage Renal Disease Following Bone Marrow Transplantation: A 10-Year Outcomes Review.

The incidence of hematopoietic stem cell transplantations (HSCTs) in the US is increasing dramatically each year. Nephrotoxic agents used in these patients often lead to kidney injury that can be severe and progress to end-stage renal disease (ESRD) requiring long term dialysis or kidney transplant. Kidney transplantation is the best method of renal replacement therapy and maintenance immunosuppression is the mainstay to prevent graft rejection. Immune tolerance is of substantial interest because it obviates the need for long-term immunosuppression.

We performed a retrospective analysis of nine patients that developed ESRD after HSCT at the Medical College of Wisconsin. Chart review was performed to obtain demographic information and details of the transplants, patient and transplant outcomes, and various renal and HSCT related parameters.

A total of nine patients were reviewed. Patient age at the time of HSCT ranged from 25-40 years. ESRD was caused by bone marrow transplant nephropathy (BMT-Np) in seven patients, HUS/TTP in one patient, and anti-TBM nephritis in one patient. Six patients received their kidney from a living related donor (LRD), whereas two patients received living unrelated renal transplants (LURRTx), and one recipient received a deceased donor transplant. Three of the six LRD recipients had same-donor renal and hematopoietic stem cell (HSC) transplants and did not require post-transplant maintenance immunosuppression. Of the two LURRTx recipients, no maintenance immunosuppression was required for the patient receiving same-donor organs. The deceased donor transplant recipient continues to be on immunosuppression. Follow-up ranges from 12-23 years post HSCT and 3-12 years post-renal transplant. Seven of the nine patients have functioning bone marrow and kidney transplants. Their serum creatinine ranges from 0.77 to 1.7 mg/dL. One patient died 24 months post-renal transplant from metastatic vaginal squamous cell cancer and had a functioning bone marrow and kidney at the time of death. Another patient was lost to follow-up and died of unknown cause, although her renal function 34 months post transplant was excellent off maintenance immunosupression.

Based on our case series, we conclude that the long-term outcome of renal allografts in patients who have received a renal transplant after HSCT is excellent. The overall requirement for immunosuppressive medications in this population is reduced.

No relevant conflicts of interest to declare.