Abstract: SA-PO052
Long-Term Outcomes of Sequential Hematopoietic Stem Cell Transplantation and Kidney Transplantation
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Moreira, Carla L., Centro Hospitalar do Porto, Porto, Portugal
- Sidiqi, M Hasib, Mayo Clinic, Rochester, Minnesota, United States
- Cosio, Fernando G., Mayo Clinic, Rochester, Minnesota, United States
- Leung, Nelson, Mayo Clinic, Rochester, Minnesota, United States
Background
Hematopoietic stem cell transplantation (HSCT) patients are known to be at risk for both acute and chronic kidney disease. Experience on sequential HSCT and kidney transplant (KT) is limited.
Methods
We conducted a retrospective cohort study of adult patients who underwent both HSCT and KT at Mayo Clinic, Rochester, between 1988 and 2018.
Results
In our cohort of 54 patients, male represented 57% (n=31) and the median age was 64.2 (56.8, 70.1) years-old. Thirty-six patients (66.7%) received HSCT first followed by KT, while 18 (33.3%) received KT prior to HSCT. In both groups, immunoglobulin related amyloidosis represented 50% of hematologic diagnosis. Living kidney donor was equally distributed in both groups, representing 83% (n=45) of the donors, with 60% (n=27) from a relative. T-cell depleting induction was significantly more frequent in the KT first group (94% vs 19%, p<0.001). Primary kidney disease recurrence was not significantly different in HSCT first vs KT first (19% vs 39%, p=0.19), and both groups displayed excellent kidney allograft survival at 1y (94% vs 89%) and 5y (94% vs 89%), p=0.51. KT first did not affect allograft outcome (HR 1.7, 95% CI 0.4-7.9, p=0.51) nor did maintenance immunosuppression (HR 2.8, 95% CI 0.6-11.9, p=0.16). Acute cell mediated rejection (ACMR) seemed to worsen KT prognosis (HR 10.7, 95% CI 1.6-71.7, p=0.01). However, in multivariate analysis, ACMR revealed only a trend towards significant worse allograft prognosis (HR 22.8, 95% CI 1.0-520.8, p=0.05). Overall patient survival was better in patients submitted to HSCT first, both at 5y (97% vs 76%) and 10y (90% vs 63%), p=0.0001. EBV seronegative status at KT (HR 2.9, 95% CI 1.1-7.8, p=0.039), KT first (HR 6.0, 95% CI 2.2-16.5, p=0.0001), use of T-cell depleting agent (HR 3.2, 95% CI 1.2-8.7, p=0.02), severe infection (HR 19.6, 95% CI 2.6-148.1, p=0.004) and renal allograft failure (HR 3.2, 95% CI 1.2-8.8, p=0.02) were significantly associated with poor patient outcome. In multivariate analysis, only history of severe infection was significantly associated with poor survival (HR 14.0, 95% CI 1.6-125.8, p=0.02).
Conclusion
Our study supports KT safety in patients with history of HSCT, with better allograft function and overall patient survival observed when HSCT is performed first.