Hingorani S, et al. - In patients who underwent hematopoietic cell transplantation (HCT), researchers studied the link between changes in GFR and all-cause mortality up to 10 years after HCT. They found a high risk of decreased eGFR in adult HCT recipients by 1 year after HCT. They noted that eGFR continued to be fairly stable thereafter. A significant association was noted between a decreased eGFR and higher risk of mortality; a progressively increased risk was observed as eGFR declined.

Methods

• This prospective, observational cohort study included adult patients undergoing HCT at the Fred Hutchinson Cancer Center in Seattle, Washington from 2003 to 2015.
• Follow-up started from baseline, before conditioning therapy, until a maximum of 10 years after transplant.
• The link between creatinine eGFR and all-cause mortality was determined using Cox proportional hazard models.
• Risk factors for decreases in eGFR were examined via time-dependent generalized estimating equations.

Results

• A median 5.3 years of follow-up was performed after HCT in 434 patients (median age, 52 years; range, 18–76 years; 64% were men; 87% were white).
• Within the first year post-transplant, occurrence of the largest decreases in eGFR was reported, with the eGFR decreasing from a median of 98 ml/min per 1.73 m² at baseline to 78 ml/min per 1.73 m² by 1 year post-HCT.
• At 1 year after transplant, an eGFR<90 ml/min per 1.73 m² was detected in two thirds of patients.
• Researchers found that when modeled as a continuous variable, as eGFR declined from approximately 60 ml/min per 1.73 m², the hazard of mortality progressively increased relative to a normal eGFR of 90 ml/min per 1.73 m² (P<0.001).
• As illustrated, the hazard ratios for eGFR of 60, 50, and 40 ml/min per 1.73 m² were 1.15 (95% confidence interval, 0.87 to 1.53), 1.68 (95% confidence interval, 1.26 to 2.24), and 2.67 (95% confidence interval, 1.99 to 3.60), respectively, relative to an eGFR of 90 ml/min per 1.73 m².
• The factors that showed independent association with a decline in GFR included diabetes, hypertension, acute graft versus host disease, and cytomegalovirus infection, whereas such an association was not shown by calcineurin inhibitor levels, chronic graft versus host disease, and albuminuria.