Kidney Injury in Adults After Hematopoietic Stem Cell Transplantation: Acute Kidney Injury, Transplant-Related Complications, and Long-Term Outcomes
4 affiliations
- 1Department of Nephrology, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia
- 2Division of Nephrology, Stadtspital Zürich, Tièchestrasse 99, 8037 Zürich, Switzerland
- 3Division of Hematology, The Ottawa Hospital, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
- 4Division of Nephrology, University Health Network, Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
Abstract
Kidney complications are common after hematopoietic stem cell transplantation (HSCT) and contribute substantially to short- and long-term morbidity and mortality. Acute kidney injury (AKI) affects a large proportion of recipients, particularly after allogeneic transplantation, and reflects the combined effects of baseline patient vulnerability, conditioning intensity, calcineurin inhibitor exposure, infection, hemodynamic disturbances, and transplant-specific complications. This review summarizes the epidemiology, risk factors, and major causes of kidney injury after HSCT, with emphasis on a time-based diagnostic approach. Important etiologies include sepsis, marrow infusion syndrome, sinusoidal obstruction syndrome, graft-versus-host disease-associated kidney injury, transplant-associated thrombotic microangiopathy, and glomerular disease. We also discuss emerging therapeutic approaches, including complement-directed therapy for transplant-associated thrombotic microangiopathy and defibrotide for sinusoidal obstruction syndrome. Beyond the acute transplant period, AKI is increasingly recognized as a major determinant of subsequent chronic kidney disease, cardiovascular risk, and impaired long-term survival. Structured surveillance of kidney function, blood pressure, and proteinuria, together with early recognition of transplant-specific syndromes and closer nephrology follow-up in high-risk patients, is therefore essential. Multidisciplinary collaboration between transplant hematology and nephrology is central to improving kidney and overall outcomes across the HSCT continuum.
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BibTeX
@article{almalki2026kidney,
title = {{Kidney Injury in Adults After Hematopoietic Stem Cell Transplantation: Acute Kidney Injury, Transplant-Related Complications, and Long-Term Outcomes}},
author = {Lamis Almalki and Nina Weber and Anup Devasia and Abhijat Kitchlu},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18213510},
url = {https://www.mdpi.com/2072-6694/18/21/3510},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Kidney Injury in Adults After Hematopoietic Stem Cell Transplantation: Acute Kidney Injury, Transplant-Related Complications, and Long-Term Outcomes
AU - Lamis Almalki
AU - Nina Weber
AU - Anup Devasia
AU - Abhijat Kitchlu
PY - 2026
DA - 2026/10/31
JO - Cancers
DO - 10.3390/cancers18213510
UR - https://www.mdpi.com/2072-6694/18/21/3510
AB - Kidney complications are common after hematopoietic stem cell transplantation (HSCT) and contribute substantially to short- and long-term morbidity and mortality. Acute kidney injury (AKI) affects a large proportion of recipients, particularly after allogeneic transplantation, and reflects the combined effects of baseline patient vulnerability, conditioning intensity, calcineurin inhibitor exposure, infection, hemodynamic disturbances, and transplant-specific complications. This review summarizes the epidemiology, risk factors, and major causes of kidney injury after HSCT, with emphasis on a time-based diagnostic approach. Important etiologies include sepsis, marrow infusion syndrome, sinusoidal obstruction syndrome, graft-versus-host disease-associated kidney injury, transplant-associated thrombotic microangiopathy, and glomerular disease. We also discuss emerging therapeutic approaches, including complement-directed therapy for transplant-associated thrombotic microangiopathy and defibrotide for sinusoidal obstruction syndrome. Beyond the acute transplant period, AKI is increasingly recognized as a major determinant of subsequent chronic kidney disease, cardiovascular risk, and impaired long-term survival. Structured surveillance of kidney function, blood pressure, and proteinuria, together with early recognition of transplant-specific syndromes and closer nephrology follow-up in high-risk patients, is therefore essential. Multidisciplinary collaboration between transplant hematology and nephrology is central to improving kidney and overall outcomes across the HSCT continuum.
SN - 2072-6694
ER -