Kidney transplantation for treatment of end-stage kidney disease after haematopoietic stem cell transplantation: case series and literature review
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The safety of kidney transplantation (KT) for end-stage kidney disease (ESKD) after haematopoietic stem cell transplantation (HSCT) for haematological disease has not been investigated thoroughly.
In this retrospective multicentre study, we investigated the clinical courses of six ESKD patients that received KT after HSCT for various haematological diseases. Data for six such patients were obtained from three institutions in our consortium.
Two patients with chronic myeloid leukaemia, one with refractory aplastic anaemia and another one with acute lymphocytic leukaemia received bone marrow transplantation. One patients with acute lymphocytic leukaemia received umbilical cord blood transplantation, and one with mantle cell lymphoma received peripheral blood stem cell transplantation. The patients developed ESKD at a median of 133 months after HSCT. Two patients who received KT and HSCT from the same donor were temporarily treated with immunosuppressive drugs. The other patients received KT and HSCT from different donors and were treated with antibody induction using our standard regimens. For one patient with ABO-incompatible transplantation, we added rituximab, splenectomy, and plasmapheresis. In the observational period at a median of 51 months after KT, only one patient experienced acute T-cell-mediated rejection. Four patients underwent hospitalization because of infection and fully recovered. No patient experienced recurrence of their original haematological disease. All patients survived throughout the observational periods, and graft functions were preserved.
Despite the high infection frequency, survival rates and graft functions were extremely good in patients compared with previous studies. Therefore, current management contributed to favourable outcomes of these patients.
KeywordsBone marrow transplantation GVHD Infection Rejection Malignancy Leukemia
End-stage kidney disease
Haematopoietic stem cell transplantation
We thank Dr Nicholas Rufaut, PhD, and Mitchell Arico from Edanz Group (http://www.edanzediting.com/ac) for editing a draft of this manuscript. We appreciate the support from Katsunori Shimada, PhD (STATZ Institute, Inc., Tokyo, Japan), who provided expert assistance with data management.
JACK Participating Centres: Department of Urology, Tokyo Women’s Medical University, Tokyo, Japan; Investigators, Kazunari Tanabe, Hideki Ishida, Masashi Inui, Kazuya Omoto, Tomokazu Shimizu, Masayoshi Okumi, Toshihito Hirai, and Daisuke Toki; Department of Medicine, Kidney Centre, Tokyo Women’s Medical University, Tokyo, Japan; Investigator, Kohei Unagami; Department of Transplant Surgery, Kidney Centre, Toda Chuo General Hospital; Investigator, Hiroshi Toma; Department of Urology, Ohkubo Hospital; Investigator, Hiroki Shirakawa; Department of Surgery and Oncology, Kyushu University, Fukuoka, Japan; Investigators, Yasuhiro Okabe, Atsuchi Doi, Keizo Kaku, and Kei Kurihara; Department of Surgery, Tomishiro Central Hospital, Okinawa; Investigator, Ota Morihito. JACK Data Centre: Katsunori Shimada, Department of Biostatistics, STATZ Institute, Inc., Tokyo, Japan. JACK General Management Office: Masayoshi Okumi, Department of Urology, Tokyo Women’s Medical University, Tokyo, Japan.
AT and KM participated in planning the research and data collection and analysis. YO, TN and MO participated in data collection. MO significantly contributed to the establishment of the consortium supporting this study. TN, KT, MN, HI and KT participated in the management of the research. All authors contributed to writing the manuscript.
Compliance with ethical standards
Conflict of interest
Potential financial conflicts of interest: Astellas Pharma Inc. (Tokyo, Japan) supported this study and Kazunari Tanabe with a grant. The sponsor was not involved in the study design, patient enrolment, data collection, analysis, interpretation, or preparation of the manuscript.
Research involving human participants
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number UMIN000018327) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Written informed consent was obtained from all individual participants included in the study.
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