Improved survival over the last decade in pediatric patients requiring dialysis after hematopoietic cell transplantation.
Improved survival over the last decade in pediatric patients requiring dialysis after hematopoietic cell transplantation.
复制标题
过去十年，造血细胞移植后需要透析的儿科患者的生存率有所提高。
DOI：
10.1016/j.bbmt.2012.12.012
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Smith,AngelaR
中科院分区：
文献类型：
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作者：
Rajpal,JuratS;Patel,Niharika;Vogel,RachelI;Kashtan,CliffordE;Smith,AngelaR
儿童在造血细胞移植（HCT）后需要透析进行液体和电解质管理并不罕见。以前的研究已经证明了HCT后需要透析的儿童的高死亡率，但缺乏最近的数据。本研究的目的是比较1990-1999年和2000-2009年20年间儿童HCT后透析的发生率和接受透析的患者的生存率。使用从机构HCT数据库前瞻性收集的数据，对1990年1月至2009年12月期间在明尼苏达大学接受首次HCT的1427例年龄<21岁的患者进行了审查。确定了2个队列中HCT后前100天的透析发生率和HCT后1年的生存率。采用χ 2检验和Fisher精确检验对需要透析和不需要透析的患者进行比较。按透析组报告HCT后1年总生存率的Kaplan-Meier估计值和95%置信区间，并使用对数秩检验进行比较。采用单变量和多变量考克斯回归分析评估需要透析患者总生存率的预测因素。两个队列的透析发生率无显著差异（1990-1999年为8.2%，2000-2009年为8.9%; P = 0.6326）。与1990-1999年队列相比，2000-2009年队列中需要透析的患者生存1年或超过1年的可能性显著更高（23%对11%; P < .0001）。多变量分析发现，HCT时年龄较大、原发疾病类型、肺出血和1990-1999年HCT与透析人群死亡率增加相关。环孢素的使用与接受透析的患者的生存率增加相关。透析是儿科HCT的重要并发症，其发生率在过去20年中保持不变。无论透析状态如何，2000-2009年队列的生存率均有所改善。尽管最近需要透析的患者的死亡率显著降低，但这些患者的死亡率仍然高于不需要透析的患者。
It is not unusual for children to require dialysis for fluid and electrolyte management after hematopoietic cell transplantation (HCT). Previous studies have documented high mortality in children who require dialysis after HCT, but recent data are lacking. The purpose of this study was to compare the incidence of dialysis after pediatric HCT and the survival of patients who received dialysis in 2 decades, 1990-1999 and 2000-2009. A total of 1427 patients age <21 years who underwent a first HCT at the University of Minnesota between January 1990 and December 2009 were reviewed using prospectively collected data from the institutional HCT database. The incidence of dialysis during the first 100 days post-HCT and survival at 1 year post-HCT in the 2 cohorts were determined. Comparisons between patients who did and did not require dialysis were made using the χ2and Fisher exact tests as appropriate. Kaplan-Meier estimates and 95% confidence intervals for 1-year post-HCT overall survival were reported by dialysis group and compared using the log-rank test. Predictors of overall survival among patients requiring dialysis were assessed using univariate and multivariate Cox regression analyses. The incidence of dialysis was not significantly different in the 2 cohorts (8.2% for 1990-1999 versus 8.9% for 2000-2009; P = .6326). Patients requiring dialysis were significantly more likely to survive to or past 1 year in the 2000-2009 cohort compared with the 1990-1999 cohort (23% versus 11%; P < .0001). Multivariate analyses found that older age at the time of HCT, primary disease type, pulmonary hemorrhage, and HCT in 1990-1999 were associated with increased mortality in the dialyzed population. The use of cyclosporine was associated with increased survival in the patients who received dialysis. Dialysis is an important complication of pediatric HCT with an incidence that has remained constant over the last 2 decades. Survival was improved in the 2000-2009 cohort regardless of dialysis status. Despite a recent significant reduction in mortality in patients requiring dialysis, mortality remains higher in these patients than in those who do not need dialysis.