ArticlePeerJ2026
Risk factors for acute kidney injury after hematopoietic stem cell transplantation in children: a single-center retrospective study.
Article in PeerJ, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To analyze the clinical characteristics and risk factors of acute kidney injury (AKI) after hematopoietic stem cell transplantation (HCT) in children. Methods: The clinical data of children who underwent HCT at our hospital from August 2016 to December 2023 were retrospectively analyzed, including age, sex, primary disease, mode of transplantation, conditioning regimen, serum creatinine (SCr) before transplantation, and the highest value of SCr from the beginning of conditioning to 100 days after transplantation. AKI was diagnosed and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, primarily based on changes in SCr. We performed univariate and multivariate logistic regression analyses to determine the risk factors for AKI, including the time of AKI onset, transplantation-related complications (sepsis, acute graft-versus-host disease (aGVHD), thrombotic microangiopathy (TMA), hepatic sinusoidal gap obstruction syndrome, hemorrhagic cystitis, cytomegalovirus infection, and Epstein-Barr virus infection). Cumulative incidence competing risk analysis was used to assess AKI incidence, with death as a competing event. Risk factors were analyzed using multivariable Cox proportional hazards regression with time-dependent covariates for post-transplantation complications. Results: A total of 299 patients were included. The cumulative incidence of AKI was 73.6% (220/299), with 131, 62, and 27 cases at Stage I, II, and III, respectively. The median time to AKI onset was 24 days (range: -4 to +91 days). Multivariable analysis showed that human leukocyte antigen (HLA) mismatch, hepatic sinusoidal obstruction syndrome (SOS), aGVHD, TMA, and cytomegalovirus/Epstein-Barr virus (CMV/EBV) infection were independent risk factors for AKI ( Conclusions: AKI is a common complication of HCT in children. HLA mismatch and post-transplantation complications are independent risk factors. Severe AKI is closely associated with poor prognosis. Early monitoring and management of AKI are crucial for improving outcomes.
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