Renal dysfunction in allogeneic hematopoietic cell transplantation
Renal dysfunction in allogeneic hematopoietic cell transplantation
复制标题
DOI：
10.1046/j.1523-1755.2002.00455.x
复制
发表时间：
2002-08-01
影响因子：
19.6
通讯作者：
Schrier, RW
中科院分区：
文献类型：
--
作者：
Parikh, CR;McSweeney, PA;Schrier, RW
背景异基因造血细胞移植（HCT），以前称为骨髓移植，可以潜在地治疗各种恶性和非恶性疾病，但它与高毒性风险相关。我们之前已经显示，在接受自体HCT的患者中，重度急性肾衰竭的总体发生率为21%。本研究评估了接受同种异体HCT的患者的肾功能不全。对在科罗拉多大学健康科学中心接受同种异体HCT的88例成人患者的临床过程进行了分析。肾功能不全分为：0级=肾功能正常; 1级= GFR下降>25%，但血清肌酐升高2倍; 3级=血清肌酐升高> 2倍，需要透析。在88例患者中，81例（92%）患者有一定程度的肾功能不全（1级，20例患者; 2级，32例患者; 3级，29例患者）。重度肾毒性（2级和3级肾功能不全）与脓毒症、肝毒性和肝静脉闭塞性疾病（VOD）以及肺毒性的发生率显著较高相关。6个月结束时的总死亡率为58%。3级肾功能不全与死亡风险显著增加相关（82.6%）。异基因HCT患者肾功能不全的发生率为92%，肺和肝毒性与肾功能不全的发生显著相关，3级肾功能衰竭患者的死亡率超过80%。
Background. Allogeneic hematopoietic cell transplantation (HCT), formerly called bone marrow transplantation, can potentially cure various malignant and non-malignant diseases, but it is associated with a high risk of toxicity. We have previously shown an overall 21% incidence of severe acute renal failure in patients undergoing autologous HCT. The present study evaluated renal dysfunction in patients undergoing allogeneic HCT.Methods. The clinical course of 88 adult patients who received allogeneic HCT at the University of Colorado Health Science Center was analyzed. Renal dysfunction was classified as follows: Grade 0 = normal renal function; Grade 1 =>25% decrement in GFR but twofold increase in serum creatinine; Grade 3 =>twofold increase in serum creatinine and need for dialysis.Results. Of the 88 patients, 81 (92%) patients had some degree of renal dysfunction (Grade 1, 20 patients; Grade 2, 32 patients; Grade 3, 29 patients). Severe nephrotoxicity (Grade 2 and Grade 3 renal dysfunction) was associated with significantly higher frequencies of sepsis, hepatic toxicity and hepatic veno-occlusive disease (VOD), and lung toxicity. The overall mortality rate at the end of 6 months was 58%. Grade 3 renal dysfunction was associated with a significantly increased risk of mortality (82.6%).Conclusion. A 92% incidence of renal dysfunction in allogeneic HCT patients was found. Lung and liver toxicities were significantly correlated with developing renal dysfunction, and the mortality rates for patients with Grade 3 renal failure exceeded 80%.