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Kidney Week

Abstract: SA-PO171

Impact of Hematopoietic Cell Transplantation Associated Thrombotic Microangiopathy on Kidney Failure Requiring Dialysis in Patients Aged 40 Years and Older Characterized by Pretransplant Kidney Health

Session Information

Category: Onconephrology

  • 1700 Onconephrology

Authors

  • Nangia, Udit, UH Parma Medical Center, Parma, Ohio, United States
  • Chandramohan, Deepak, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Garapati, Hari Naga, Baptist Medical Center South, Montgomery, Alabama, United States
  • Simhadri, Prathap, AdventHealth East Florida, Daytona Beach, Florida, United States
Background

Allogeneic hematopoietic cell transplantation (all-HCT) associated thrombotic microangiopathy (TA-TMA) and pre-transplant renal dysfunction are recognized risk factors for mortality after all-HCT. In a recent observational study (Farhadfar et al, 2021), patients with pre-transplant decreased kidney function had higher risks of renal failure requiring dialysis (RFD). Using the same data from the Center for International Blood and Marrow Transplant Research (CIBMTR), we investigated the association between onset of TA-TMA and pre-HCT renal dysfunction on RFD.

Methods

All-HCT recipients of age ≥40 years between 2008-2016 were included in this secondary analysis. We evaluated TA-TMA as a time-dependent covariate, while pre-transplant renal health and other risk factors were included as fixed covariates in a multivariate Cox regression model for RFD. Cumulative hazards of RFD in patients with and without onset of TA-TMA were estimated.

Results

The incidence of TA-TMA was not significantly different between the renal function groups. As expected, renal dysfunction was a significant risk factor for RFD when compared to eGFR ≥60 mL/min group. TA-TMA was significantly associated with increased risk (5.9-fold compared to No TA-TMA) for RFD, the highest of all the significant risk factors (Table 1). Estimated cumulative hazard for patients with TA-TMA in the two pre-HCT renal function groups were significantly elevated when compared to similar patients with No TA-TMA (52% vs 9% for eGFR <60 mL/min and 22% vs 4% for eGFR ≥60 mL/min group, respectively) at 12 months post-HCT.

Conclusion

Our results demonstrate that the adjusted hazard ratio of renal failures requiring dialysis and cumulative hazard were much higher in patients with onset of TA-TMA vs No TA-TMA, emphasizing the need for therapies for preventing and addressing TA-TMA.