In summary, the consideration of renal injury and dysfunction with HCT must involve the specific procedure used. Severe ARF occurs with all three varieties of HCT. However, in our studies the frequency of ARF (Grade 2 and 3) increases significantly from myeloablative autologous (21%) to non-myeloablative allogeneic (40%) to myeloablative allogeneic (69%). This increase in ARF correlates with a parallel increase in mortality from 7 to 34% to 58% at 6-12 months as well as progressive multiorgan involvement. With all three HCT procedures, the combination of ARF and dialysis, particularly with mechanical ventilation, the mortality increases to greater than 80%. Thus, efforts to decrease the frequency and severity of ARF in both myeloablative and non-myeloablative allogeneic HCT should be pursued in order to decrease morbidity and mortality in these patients. Nephrologists should be involved early in the care of the patient receiving allogeneic HCT to identify small decrements in renal function, assist in fluid balance and medication dosing. Guidelines for timing, dose duration and modality of dialysis for ARF in the setting of HCT are clearly needed. Also, future studies need to identify interventions and strategies that will focus on decreasing ARF and subsequent mechanical ventilation following HCT.
- Stem cell transplantation
ASJC Scopus subject areas