Feasibility and outcomes of kidney transplantation in patients with end-stage kidney disease after haemopoietic stem cell transplantation.

BACKGROUND

Advances in haemopoietic stem cell transplantation (HSCT) have improved long-term survival, but they have also led to late complications, such as nephropathy. However, the safety and feasibility of kidney transplantation (KT) in patients with HSCT-related end-stage kidney disease (ESKD) remain unclear.

AIM: This study aimed to evaluate the feasibility and clinical outcomes of KT in patients with ESKD following HSCT.

METHODS

This study retrospectively analysed eight patients with ESKD who underwent KT following HSCT for haematologic disorders, including aplastic anaemia (n = 5), acute myeloid leukaemia (n = 2) and chronic myeloid leukaemia (n = 1).

RESULTS

The median time to progression to ESKD was 104 months after HSCT, with a median interval of 138 months between HSCT and KT. The causes of ESKD included diabetic nephropathy (n = 1), hypertensive nephropathy (n = 1), focal segmental glomerulosclerosis (n = 1), thrombotic microangiopathy (n = 1) and unknown aetiology (n = 4), with three diagnoses confirmed through kidney biopsy. Three patients received both HSCT and KT from the same donor, allowing them to completely discontinue immunosuppressive therapy. During a median follow-up of 55 months (range 2-143 months), there was only one case of acute T-cell-mediated rejection, and one patient died from sepsis due to a urinary tract infection. Notably, none of the patients experienced a recurrence of their original haematologic disease.

CONCLUSION

Despite concerns regarding immunosuppression and the risk of infection in this high-risk population, both patient and graft outcomes were favourable. These findings suggest that KT is a feasible and effective treatment option for patients with ESKD following HSCT, particularly when managed with personalised strategies.