55 research outputs found
Chronic kidney disease ten years after pediatric allogeneic hematopoietic stem cell transplantation
Chronic kidney disease (CKD) is an important sequela of hematopoietic stem cell transplantation (HSCT), but data regarding CKD after pediatric HSCT are limited. In this single center cohort study, we evaluated the estimated glomerular filtration rate (eGFR) dynamics, proteinuria and hypertension in the first decade after HSCT and assessed risk factors for CKD in 216 pediatric HSCT survivors, transplanted 2002-2012. The eGFR decreased from a median of 148 to 116 ml/min/1.73 m(2) between pre-HSCT to ten years post-HSCT. CKD (KDIGO stages G2 or A2 or more; eGFR under 90 ml/min/1.73 m(2) and/or albuminuria) occurred in 17% of patients. In multivariate analysis, severe prolonged stage 2 or more acute kidney injury (AKI), with an eGFR under 60ml/min/1.73 m(2) and duration of 28 days or more, was the main risk factor for CKD (hazard ratio 9.5, 95% confidence interval 3.4-27). Stage 2 or more AKI with an eGFR of 60ml/min/1.73 m(2) or more and KDIGO stage 2 or more AKI with eGFR under 60ml/min/1.73 m(2) but recovery within 28 days were not associated with CKD. Furthermore, hematological malignancy as HSCT indication was an independent risk factor for CKD. One third of patients had both CKD criteria, one third had isolated eGFR reduction and one third only had albuminuria. Hypertension occurred in 27% of patients with CKD compared to 4.4% of patients without. Tubular proteinuria was present in 7% of a subgroup of 71 patients with available beta 2-microglobulinuria. Thus, a significant proportion of pediatric HSCT recipients developed CKD within ten years. Our data stress the importance of structural long-term monitoring of eGFR, urine and blood pressure after HSCT to identify patients with incipient CKD who can benefit from nephroprotective interventions.Diabetes mellitus: pathophysiological changes and therap
Alemtuzumab Induction and Delayed Acute Rejection in Steroid-Free Simultaneous Pancreas-Kidney Transplant Recipients
Transplantation and immunomodulatio
Abnormalities in T cell differentiation in patients with the Lambert-Eaton myasthenic syndrome
Neurological Motor Disorder
Early CMV reactivation after stem cell transplantation leaves an imprint on the CD8+T-lymphocyte compartment one year post transplantation
Transplantation and immunomodulatio
Impact of serotherapy on the outcome after stem cell transplantation in children: ATG versus Campath-1H
Transplantation and immunomodulatio
Sensibilization of severe aplastic anaemia patients to thymoglobulin (ATG) impairs the efficacy of ATG in haematopoietic stem cell transplantation (HSCT) conditioning
Transplantation and immunomodulatio
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