ACUTE-RENAL-FAILURE IN PATIENTS FOLLOWING BONE-MARROW TRANSPLANTATION - PREVALENCE, RISK-FACTORS AND OUTCOME
ACUTE-RENAL-FAILURE IN PATIENTS FOLLOWING BONE-MARROW TRANSPLANTATION - PREVALENCE, RISK-FACTORS AND OUTCOME
复制标题
DOI：
10.1159/000168889
复制
发表时间：
1995-11-01
影响因子：
4.2
通讯作者：
FERNANDEZRANADA, JM
中科院分区：
文献类型：
--
作者：
GRUSS, E;BERNIS, C;FERNANDEZRANADA, JM
对275例骨髓移植术后急性肾功能衰竭（ARF）的发生率、危险因素、临床原因和转归进行了回顾性分析。72例患者（26%）被诊断为ARF，81.9%的患者在第一个月内发生。三个主要的临床原因是多因素（36%），肾毒性（29%）和肝静脉闭塞性疾病（VOD）15%。异基因骨髓移植的患病率（36%）高于自体骨髓移植（6.5%）。与ARF发生相关的危险因素是既往存在VOD和年龄大于25岁。异基因BMT的Logistic回归证实了这种关联（VOD，优势比3.8;年龄小于25岁，优势比1.9）。基础疾病、移植物抗宿主病、败血症、预处理治疗和性别与ARF无关。17例ARF需要血液透析（24%），主要与VOD相关（70.5%）。ARF的总死亡率为45.8%，透析组的死亡率最高（88%）。ARF组的生存率持续恶化至3个月，10年的精算生存率为29.7%与53.2%。我们认为ARF是一种常见的并发症，主要发生在异基因骨髓移植中，预后严重。VOD和年龄是ARF的危险因素。
To assess the prevalence, risk factors, clinical causes and outcome of acute renal failure (ARF) following bone marrow transplantation (BMT), a retrospective analysis of 275 patients was undertaken. ARF was diagnosed in 72 patients (26%) and occurred in 81.9% within the first month. The three main clinical causes were multifactorial (36%), nephrotoxic (29%), and veno-occlusive disease of the liver (VOD) 15%. The prevalence was higher in allogeneic BMT (36%) than in autologous BMT (6.5%). Risk factors related to the development of ARF were preexisting VOD and age older than 25 years. Logistic regression in allogeneic BMT confirmed this association (VOD, odds ratio 3.8; age ofer than 25, odds ratio 1.9). Underlying disease, graft-versus-host disease, sepsis, conditioning therapy, and sex were not associated with ARF. Seventeen cases of ARF required hemodialysis (24%) mainly in association with VOD (70.5%). The overall mortality from ARF was 45.8%, the dialyzed group having the highest mortality (88%). Survival in the ARF group was continuously worse up to 3 months and the actuarial survival at 10 years was 29.7 versus 53.2%. We conclude that ARF is a common complication mainly in allogeneic BMT and carries a grave prognosis. VOD and age were risk factors for ARF.