Influence of pre-transplant estimated glomerular filtration rate (eGFR) on clinical outcomes after allogeneic hematopoietic cell transplantation

TL;DR

This study shows that lower kidney function before a bone marrow transplant increases the risk of transplant-related death, highlighting the importance of preserving kidney health before the procedure.

Contribution

The study identifies a specific eGFR threshold (<70 ml/min) associated with increased transplant-related mortality in the contemporary era of allogeneic hematopoietic cell transplantation.

Findings

Patients with pre-transplant eGFR <70 ml/min had the highest risk for non-relapse mortality (p < 0.0001).

Multivariate analysis confirmed that eGFR <70 ml/min was significantly associated with increased transplant-related mortality.

Higher eGFR categories showed no significant differences in mortality risk.

Abstract

Pretransplant renal dysfunction has historically been associated with increased non-relapse mortality (NRM) and inferior overall survival. Novel approaches in conditioning and GVHD prophylaxis have reduced the toxicity of transplant over time, however, the impact of pre-transplant eGFR in the contemporary era is unknown. The aim of this study was to identify a pre-transplant eGFR value associated with increased transplant-related mortality. This retrospective study was performed using data from 724 adult patients who underwent first allogeneic hematopoietic cell transplant (alloHCT) from January 2012 through December 2021. The optimal pre-transplant eGFR value for risk of NRM was identified using Cox-restricted cubic spline plot analysis. Those with an eGFR <70 ml/min had the highest risk for NRM (p < 0.0001). Multivariate analysis confirmed that the risk of NRM remained significantly higher for eGFR <70 ml/min compared to the other higher eGFR categories, while there were no significant differences between the higher eGFR categories. Pre-transplant renal dysfunction is associated with poor outcomes after alloHCT and remains an important criterion when considering patients for transplant. Efforts to preserve renal function prior to transplant by limiting nephrotoxic exposures may have implications for optimizing outcomes after transplant, particularly in patients with other comorbidities.

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