Kidney Week

Abstract: FR-OR79

Post-transplantation Cyclophosphamide-Based Regimen for Graft-vs.-Host Disease Prophylaxis Reduces Risk of CKD in Allogenic Stem-Cell Transplant Recipients

Session Information

• Onconephrology: Models, Markers, and Medications
  October 25, 2024 | Location: Room 33, Convention Center
  Abstract Time: 05:30 PM - 05:40 PM

Category: Onconephrology

• 1700 Onconephrology

Authors

• Klair, Nathaniel, University of Minnesota Twin Cities Division of Nephrology and Hypertension, Minneapolis, Minnesota, United States

Nathaniel Klair, MD

• Holtan, Shernan, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States

Shernan Holtan, MD

• Klomjit, Nattawat, University of Minnesota Twin Cities Division of Nephrology and Hypertension, Minneapolis, Minnesota, United States

Nattawat Klomjit, MD, FASN

Background

Allogenic stem cell transplant (Allo-SCT) is associated with higher risk of acute kidney injury (AKI) and chronic kidney disease (CKD). Post-transplantation cyclophosphamide (PTCy)-based regimen for graft-versus-host disease (GVHD) prophylaxis has emerged as a new paradigm in reducing GVHD risk by up to 40%. However, little is known about the impact of kidney outcomes in a PTCy-based regimen.

Methods

We included all adult patients (age ≥ 18 years) who underwent Allo-SCT at the University of Minnesota Medical Center between 1/1/2015 and 5/31/2022. Patients were categorized based on their GVHD prophylaxis: PTCy-based regimen (PTCy/Tacrolimus/Mycophenolate), calcineurin inhibitor (CNI) -based regimen and others. Outcomes include AKI at day 100 (D100), dialysis at D100, eGFR at 1 year and CKD at last follow-up.

Results

We included 488 patients in our cohort, of which 166 (34.0%) received PTCy, 276 (56.6%) received CNI and 46 (9.4%) received other GVHD prophylaxis. Mean age was 54.3 ±15.0 years and the majority were male (59.8%). Baseline eGFR was 107.2±16.6 ml/min/1.73m² and only 9 (1.8%) patients had CKD at baseline. PTCy [157 (94.6%)] and CNI-based regimens [255 (92.4%)] had a significantly higher rate of AKI at D100 than the other group [21 (45.7%)]. However, there were no difference in the rate of AKI stage 3 and dialysis among groups (p>0.05). However, eGFR at 1 year was not different. CNI toxicity was the most common cause of AKI in PTCy and CNI groups whereas pre-renal cause was the most common cause of AKI in the other group. At last follow-up, PTCy [31 (18.7%)] had the lowest rate of CKD compared to CNI-based [86 (31.2%)] and the other group [14 (30.4%)]. Multivariate analysis showed that the PTCy group had significantly lower risk of CKD compared to the CNI-based group with OR 0.23 (95% CI 0.09-0.57). Furthermore, PTCy had lower rates of thrombotic microangiopathy, veno-occlusive disease, acute GVHD and chronic GVHD compared to the CNI-based regimen

Conclusion

Although AKI is common in the PTCy regimen, most patients recover and sustain comparable eGFR to CNI and the other regimens at 1 year. PTCy also demonstrates the lowest rate of CKD and is possibly due to lower transplant-related complications such as acute and chronic GVHD.