ACUTE-RENAL-FAILURE IN PATIENTS FOLLOWING BONE-MARROW TRANSPLANTATION- PREVALENCE, RISK-FACTORS AND OUTCOME

To assess the prevalence, risk factors, clinical causes and outcome of acute renal failure (ARF) following bone marrow transplantation (BMT) , a retrospective analysis of 275 patients was undertaken. ARF was dia gnosed in 72 patients (26%) and occurred in 81.9% within the first mon th. The three main clinical causes were multifactorial (36%), nephroto xic (29%), and veno-occlusive disease of the liver (VOD) 15%. The prev alence was higher in allogeneic BMT (36%) than in autologous BMT (6.5% ). Risk factors related to the development of ARF were preexisting VOD and age older than 25 years. Logistic regression in allogeneic BMT co nfirmed this association (VOD, odds ratio 3.8; age ofer than 25, odds ratio 1.9). Underlying disease, graft-versus-host disease, sepsis, con ditioning therapy, and sex were not associated with ARF. Seventeen cas es of ARF required hemodialysis (24%) mainly in association with VOD ( 70.5%). The overall mortality from ARF was 45.8%, the dialyzed group h aving the highest mortality (88%). Survival in the ARF group was conti nuously worse up to 3 months and the actuarial survival at 10 years wa s 29.7 versus 53.2%. We conclude that ARF is a common complication mai nly in allogeneic BMT and carries a grave prognosis. VOD and age were risk factors for ARF.