Postmortem examination of the kidney in allogeneic hematopoietic stem cell transplantation recipients: possible involvement of graft-versus-host disease

• Published in: International journal of hematology 2008-03, Vol.87 (2), p.225-230
• Main Authors: Kusumi, Eiji, Kami, Masahiro, Hara, Shigeo, Hoshino, Junichi, Yamaguchi, Yutaka, Murashige, Naoko, Kishi, Yukiko, Shibagaki, Yugo, Shibata, Taro, Matsumura, Tomoko, Yuji, Koichiro, Masuoka, Kazuhiro, Wake, Atsushi, Miyakoshi, Shigesaburo, Taniguchi, Shuichi
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Case-Control Studies; Female; Graft vs Host Disease - complications; Hematologic and hematopoietic diseases; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Kidney - pathology; Kidney Diseases - etiology; Kidney Diseases - pathology; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Oncology; Original Article; Transplantation, Homologous; Tubulopathies
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-008-0026-2

To investigate the association between graft-versus-host disease (GVHD) and renal injury after allogeneic stem cell transplantation (allo-SCT), we compared autopsy findings of 26 consecutive allo-SCT recipients with two control groups: patients with hematologic malignancies who received cytotoxic chemotherapy alone (Control 1, n = 21) and those with non-hematologic diseases (Control 2, n = 12). We evaluated the following renal pathology; renal tubulitis, allograft glomerulitis, intimal arteritis, allograft nephropathy, and peritubular capillaritis. These changes were found in 11 allo-SCT recipients and 10 patients in Control 1, but none in Control 2. While overall frequency of renal impairments was similar between allo-SCT recipients and Control 1 (3/26 vs. 1/21), allo-SCT recipients were more likely to have renal tubulitis and peritubular capillaritis compared to Control 1 (5/26 vs. 1/21), but less likely to present with glomerulitis (1/26 vs. 6/21). Grade III–IV acute or extensive-type chronic GVHD were seen in all of the three patients with renal tubulitis and four of the five patients with peritubular capillaritis. Allo-SCT recipients with severe GVHD tended to have tubulitis and peritubular capillaritis. These findings have implications of some renal impairment attributable to GVHD.