造血干细胞移植术后肾损伤的临床病理表现及预后分析

Clinicopathological features and prognosis of kidney injury in patients after hematopoietic stem cell transplantation

探讨造血干细胞移植(hematopoietic stem cell transplantation,HSCT)后肾脏损伤的临床病理表现及预后,为预防其发生发展提供依据。采用回顾性队列研究方法,收集2011年6月至2021年6月在北京大学第一医院肾内科住院的HSCT术后出现肾脏损伤,并行肾穿刺活检的所有患者临床及肾穿刺病理资料,电话随访其预后,分析此26例患者的临床实验室特点、肾脏病理及预后,分析肾脏损伤的临床表型及临床与病理的对应关系,并分析影响预后的危险因素。结果显示,HSCT后肾脏损伤临床表现以慢性肾脏病(chronic kidney disease,CKD)为主(69.2%,18/26),以CKD为临床表现的患者中半相合移植患者比例更高(13/18),且更多合并肾外移植物抗宿主病(graft-versus-host disease,GVHD)表现(11/18)。病理类型以血栓性微血管病(thrombotic microangiopathy,TMA)肾损伤最多见(61.5%,16/26)。有6例患者肾脏恢复至基线状态,肾脏2年存活率为95.7%(22/23),肾脏5年存活率为87.5%(14/16)。综上,HSCT后肾脏损伤的临床表现以CKD为主,病理类型以TMA最多见,远期预后良好。

To summarize the clinicopathological features and prognosis of kidney injury after hematopoietic stem cell transplantation(HSCT),to provide basis for preventing its occurrence and development.By using a retrospective cohort study method,we collected the clinical and renal biopsy pathological data of all the patients who hospitalized in the Department of Nephrology of Peking University First Hospital from June 2011 to June 2021 with renal injury after HSCT and underwent renal biopsy,and prognosis was followed up by telephone.The clinical laboratory characteristics,renal pathology and prognosis,and their association were analyzed.The results showed that the most common clinical phenotype was chronic kidney disease(CKD,69.2%,18/26),in this term 13/18 patients received stem cells from haploidentical donors,and 11/18 patients experienced with extrarenal graft-versus-host disease(GVHD).The most common pathologic phenotype was thrombotic microangiopathy(TMA,61.5%,16/26).Renal function returned to baseline level in 6 patients,and the kidney survival at 2 years and 5 years were 95.7%(22/23)and 87.5%(14/16),respectively.In conclusion,the clinical phenotype of renal injury after HSCT were mainly CKD,and the most common pathologic phenotype was TMA,the long-term prognosis was favourable.