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The role of continuous renal replacement therapy in the management of acute kidney injury associated with sinusoidal obstruction syndrome following hematopoietic cell transplantation
Author(s) -
Raina Rupesh,
Abusin Ghada A.,
Vijayaraghavan Prashant,
Auletta Jeffery J.,
Cabral Linda,
Hashem Hasan,
Vogt Beth A.,
Cooke Kenneth R.,
AbuArja Rolla F.
Publication year - 2018
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13139
Subject(s) - medicine , renal replacement therapy , acute kidney injury , diuretic , retrospective cohort study , transplantation , furosemide , surgery
Abstract Maintaining fluid balance, pre‐ and post‐MA‐HCT is essential and usually requires frequent administration of diuretics. Hepatic sinusoidal obstructive syndrome is potentially life‐threatening, especially when associated with AKI and MOF. This study describes six patients who developed AKI ‐associated SOS and diuretic‐resistant FO who subsequently underwent CRRT using standardized management guidelines for fluid balance post‐ HCT . Retrospective chart review was done for HCT patients between September 2011 and October 2013 at a tertiary care children's hospital. Thirty‐four patients underwent MA ‐ HCT in the study period. Six patients had SOS complicated by diuretic‐resistant FO and underwent CRRT . Defibrotide was used in three patients. Median time on CRRT was 10.5 days. Sixty‐six percent (N = 4 of 6) of patients had full resolution of SOS symptoms with a mortality rate of 34% (N = 2 of 6). Among patients who had full recovery of SOS symptoms, one patient developed AKI , end‐stage renal diseases and underwent kidney transplantation 34‐months post‐ HCT . Thus, of six included patients, two died and one developed ESRD with only 50% (N = 3 of 6) good outcome. Use of a standardized, evidence‐based fluid balance protocol and early initiation of CRRT for HCT ‐related AKI / SOS was associated with good outcomes.