Acute Kidney Injury in Patients with Systemic Sclerosis Participating in Hematopoietic Cell Transplantation Trials in the United States

Chitra Hosing, Richard Nash, Peter McSweeney, Shin Mineishi, James Seibold, Linda M. Griffith, Howard Shulman, Ellen Goldmuntz, Maureen Mayes, Chirag Parikh, Leslie Crofford, Lynette Keyes-Elstein, Daniel Furst, Virginia Steen, Keith M. Sullivan

Research output: Contribution to journalArticle

Abstract

Recipients of hematopoietic cell transplantation may be at risk for developing acute kidney injury (AKI), and this risk may be increased in patients who undergo transplantation for severe systemic sclerosis (SSc) due to underlying scleroderma renal disease. AKI after transplantation can increase treatment-related mortality. To better define these risks, we analyzed 91 patients with SSc who were enrolled in 3 clinical trials in the United States of autologous or allogeneic hematopoietic cell transplantation (HCT). Eleven (12%) of the 91 patients with SSc in these studies (8 undergoing autologous HCT, 1 undergoing allogeneic HCT, 1 pretransplantation, 1 given i.v. cyclophosphamide on a transplantation trial) experienced AKI, of whom 8 required dialysis and/or therapeutic plasma exchange. AKI injury in the 9 HCT recipients developed a median of 35 days (range, 0-90 days) after transplantation. Ten of 11 patients with AKI received angiotensin-converting enzyme inhibitor (ACE-I) therapy. The etiology of AKI was attributed to scleroderma renal crisis in 6 patients (including 2 with normotensive renal crisis), to AKI of uncertain etiology in 2 patients, and to AKI superimposed on scleroderma kidney disease in 3 patients. Eight of the 11 patients died, one each because of progression of SSc, multiorgan failure, gastrointestinal and pulmonary bleeding, pericardial tamponade and pulmonary complications, diffuse alveolar hemorrhage, pulmonary embolism, graft-versus-host disease, and malignancy. Limiting nephrotoxins, cautious use of corticosteroids, renal shielding during total body irradiation, strict control of blood pressure, and aggressive use of ACE-Is may be of importance in preventing renal complications after HCT for SSc.

Original languageEnglish (US)
Pages (from-to)674-681
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume17
Issue number5
DOIs
StatePublished - May 1 2011

Fingerprint

Systemic Scleroderma
Cell Transplantation
Acute Kidney Injury
Kidney
Transplantation
Hemorrhage
Enzyme Therapy
Lung
Cardiac Tamponade
Plasma Exchange
Whole-Body Irradiation
Kidney Diseases
Graft vs Host Disease
Pulmonary Embolism
Angiotensin-Converting Enzyme Inhibitors
Cyclophosphamide
Dialysis
Adrenal Cortex Hormones
Clinical Trials
Blood Pressure

Keywords

  • Renal complications
  • Scleroderma

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Acute Kidney Injury in Patients with Systemic Sclerosis Participating in Hematopoietic Cell Transplantation Trials in the United States. / Hosing, Chitra; Nash, Richard; McSweeney, Peter; Mineishi, Shin; Seibold, James; Griffith, Linda M.; Shulman, Howard; Goldmuntz, Ellen; Mayes, Maureen; Parikh, Chirag; Crofford, Leslie; Keyes-Elstein, Lynette; Furst, Daniel; Steen, Virginia; Sullivan, Keith M.

In: Biology of Blood and Marrow Transplantation, Vol. 17, No. 5, 01.05.2011, p. 674-681.

Research output: Contribution to journalArticle

Hosing, C, Nash, R, McSweeney, P, Mineishi, S, Seibold, J, Griffith, LM, Shulman, H, Goldmuntz, E, Mayes, M, Parikh, C, Crofford, L, Keyes-Elstein, L, Furst, D, Steen, V & Sullivan, KM 2011, 'Acute Kidney Injury in Patients with Systemic Sclerosis Participating in Hematopoietic Cell Transplantation Trials in the United States', Biology of Blood and Marrow Transplantation, vol. 17, no. 5, pp. 674-681. https://doi.org/10.1016/j.bbmt.2010.08.003
Hosing, Chitra ; Nash, Richard ; McSweeney, Peter ; Mineishi, Shin ; Seibold, James ; Griffith, Linda M. ; Shulman, Howard ; Goldmuntz, Ellen ; Mayes, Maureen ; Parikh, Chirag ; Crofford, Leslie ; Keyes-Elstein, Lynette ; Furst, Daniel ; Steen, Virginia ; Sullivan, Keith M. / Acute Kidney Injury in Patients with Systemic Sclerosis Participating in Hematopoietic Cell Transplantation Trials in the United States. In: Biology of Blood and Marrow Transplantation. 2011 ; Vol. 17, No. 5. pp. 674-681.
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