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Hyperferritinemia and acute kidney injury in pediatric patients receiving allogeneic hematopoietic cell transplantation

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Abstract

Background

Acute kidney injury (AKI) often occurs in pediatric patients who received allogeneic hematopoietic cell transplantation (HCT). We evaluated the risk and effect of HCT-related AKI in pediatric patients.

Methods

We retrospectively studied the survival and renal outcome of 69 children 100 days and 1-year posttransplant in our institution in 2004–2016. Stage-3 AKI developed in 34 patients (49%) until 100 days posttransplant.

Results

The 100-day overall survival (OS) rates of patients with stage-3 AKI were lower than those without it (76.5% vs. 94.3%, P = 0.035). The 1-year OS rates did not differ markedly between 21 post-100-day survivors with stage-3 AKI and 29 without it (80.8% vs. 87.9%, P = 0.444). The causes of 19 deaths included the relapse of underlying disease or graft failure (n = 11), treatment-related events (4), and second HCT-related events (4). Underlying disease of malignancy (crude hazard ratio (HR) 5.7; 95% confidence interval (CI), 2.20 to 14.96), > 1000 ng/mL ferritinemia (crude HR 4.29; 95% CI, 2.11 to 8.71), stem cell source of peripheral (crude HR 2.96; 95% CI, 1.22 to 7.20) or cord blood (crude HR 2.29; 95% CI, 1.03 to 5.06), and myeloablative regimen (crude HR 2.56; 95% CI, 1.24 to 5.26), were identified as risk factors for stage-3 AKI until 100 days posttransplant. Hyperferritinemia alone was significant (adjusted HR 5.52; 95% CI, 2.21 to 13.76) on multivariable analyses.

Conclusions

Hyperferritinemia was associated with stage-3 AKI and early mortality posttransplant. Pretransplant iron control may protect the kidney of pediatric HCT survivors.

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Abbreviations

AKI:

Acute kidney injury

HCT:

Hematopoietic cell transplantation

OS:

Overall survival

HR:

Hazard ratio

CI:

Confidence interval

HLA:

Human leukocyte antigen

TBI:

Total body irradiation

VOD:

Veno-occlusive disease

GVHD:

Graft-versus-host disease

CMV:

Cytomegalovirus

SOS:

Sinusoidal obstruction syndrome

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Acknowledgements

We thank Emeritus Prof. Toshiro Hara, Prof. Akinobu Matsuzaki, Dr. Takeshi Inamitsu, Dr. Aiko Suminoe, and Prof. Hidetoshi Takada (belonged to Department of Pediatrics, Kyushu University Hospital), along with all of the staff who treated the patients in Kyushu University Hospital.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Mari Kurokawa, Kei Nishiyama, Yuhki Koga, Katsuhide Eguchi, Takashi Imai, Utako Oba, Akira Shiraishi, Hazumu Nagata, Noriyuki Kaku, Masataka Ishimura & Shouichi Ohga

  2. Pediatric Intensive Care Unit, Kyushu University Hospital, Fukuoka, Japan

    Noriyuki Kaku

  3. Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan

    Satoshi Honjo

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  1. Mari Kurokawa
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Contributions

MK, KN, YK, and SO were the principal investigators, taking primary responsibility for the paper. KE, TI, UO, AS, and MI performed the clinical management with helpful discussion regarding the completion of the work. HN and NK conducted critical care. SH gave advice on the statistical analyses.

Corresponding author

Correspondence to Yuhki Koga.

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Kurokawa, M., Nishiyama, K., Koga, Y. et al. Hyperferritinemia and acute kidney injury in pediatric patients receiving allogeneic hematopoietic cell transplantation. Pediatr Nephrol 35, 1977–1984 (2020). https://doi.org/10.1007/s00467-020-04619-y

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  • DOI: https://doi.org/10.1007/s00467-020-04619-y

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