Acute Kidney Injury and CKD Associated with Hematopoietic Stem Cell Transplantation

Clin J Am Soc Nephrol. 2020 Feb 7;15(2):289-297. doi: 10.2215/CJN.08580719. Epub 2019 Dec 13.


Hematopoietic stem cell transplantation is a life-saving therapy for many patients with cancer, as well as patients with some nonmalignant hematologic disorders, such as aplastic anemia, sickle cell disease, and certain congenital immune deficiencies. Kidney injury directly associated with stem cell transplantation includes a wide range of structural and functional abnormalities, which may be vascular (hypertension, thrombotic microangiopathy), glomerular (albuminuria, nephrotic glomerulopathies), and/or tubulointerstitial. AKI occurs commonly after stem cell transplant, affecting 10%-73% of patients. The cause is often multifactorial and can include sepsis, nephrotoxic medications, marrow infusion syndrome, hepatic sinusoidal obstruction syndrome, thrombotic microangiopathy, infections, and graft versus host disease. The risk of post-transplant kidney injury varies depending on patient characteristics, type of transplant (allogeneic versus autologous), and choice of chemotherapeutic conditioning regimen (myeloablative versus nonmyeloablative). Importantly, AKI is associated with substantial morbidity, including the need for KRT in approximately 5% of patients and the development of CKD in up to 60% of transplant recipients. AKI has been associated universally with higher all-cause and nonrelapse mortality regardless of transplant type, and studies have consistently shown extremely high (>80%) mortality rates in those patients requiring acute dialysis. Accordingly, prevention, early recognition, and prompt treatment of kidney injury are essential to improving kidney and patient outcomes after hematopoietic stem cell transplantation, and for realizing the full potential of this therapy.

Keywords: acute kidney injury; acute renal failure; albuminuria; aplastic anemia; bone marrow; chronic kidney disease; chronic renal insufficiency; graft versus host disease; hematopoietic stem cell transplantation; hepatic veno-occlusive disease; humans; hypertension; kidney; neoplasms; oncology; renal dialysis; sepsis; sickle cell anemia; stem cell; thrombotic microangiopathies; transplant recipients; transplantation conditioning.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / etiology*
  • Acute Kidney Injury / mortality
  • Acute Kidney Injury / therapy
  • Early Diagnosis
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Incidence
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / etiology*
  • Renal Insufficiency, Chronic / mortality
  • Renal Insufficiency, Chronic / therapy
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome