Contributing Factors to Renal Dysfunction during Engraftment Syndrome

Purpose: Engraftment syndrome (ES) is a complication of autologous hematopoietic stem cell transplantation (HSCT) characterized by non-infectious fever, skin rash, diarrhea, and inflammatory manifestations. Acute renal dysfunction is a less frequently reported complication of ES, occurring in up to 26% of patients. No prior investigation has identified specific risk factors for developing acute renal failure in this patient population. The objective of this study is to determine risk factors associated with the development of acute renal dysfunction in patients with ES.

Methods: This study will be submitted to the University of Texas Health Science Center and Veterans Affairs Institutional Review Board for approval. This retrospective cohort study will identify all patients receiving autologous HSCT from January 2011 to December 2013 at a single institution. Patients with a diagnosis of ES (per the Maiolino criteria: non-infectious fever plus one of the following: skin rash, pulmonary infiltrates, or diarrhea which commences 24 hours before, or any time after appearance of neutrophils) will be identified. Potential risk factors that may lead to the development of acute renal dysfunction during the time of ES will be analyzed. Data collected will include: baseline demographics, underlying malignancy, comorbid conditions, mobilization regimen, conditioning regimen, number of CD34 cells infused, time of engraftment, date of first fever, physical examination, medications, clinical lab values, and length of hospital admission. Descriptive statistical analyses will be performed for discrete variables by using Pearson’s chi-squared test or Fisher’s exact test appropriately. Risk factors will be analyzed using a backward stepwise logistic regression model.