-Review-

Renal Complications after Hematopoietic Stem Cell Transplantation: Role of Graft-Versus-Host Disease in Renal Thrombotic Microangiopathy

Akiko Mii¹, Akira Shimizu², Hiroki Yamaguchi³ and Shuichi Tsuruoka¹

¹Department of Nephrology, Nippon Medical School, Tokyo, Japan
²Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
³Department of Hematology, Nippon Medical School, Tokyo, Japan

Hematopoietic stem cell transplantation (HSCT) is a widely accepted treatment for mainly hematopoietic disorders. Recent advances in transplantation techniques have increased the number of long-time survivors with chronic kidney disease (CKD). The presence of CKD affects outcomes and is associated with high mortality rates. Therefore, physicians treating transplant survivors should consider renal complications and optimize management of patients with CKD after HSCT. The pathology of CKD after HSCT is affected by many factors, and the causes of renal thrombotic microangiopathy (TMA) are diverse and complicated. We have treated patients who underwent allogeneic HSCT and developed late-stage renal TMA possibly associated with graft-versus-host disease (GVHD). Administration of immunosuppressive drugs, such as calcineurin inhibitors, is typically reduced in patients with TMA. However, if renal TMA is caused by renal GVHD, the use of immunosuppressive drugs should be increased, contradicting conventional thinking. On the basis of previous findings and our own observations, we review the pathology of renal complications after HSCT and focus on the role of GVHD in the development of renal TMA.

J Nippon Med Sch 2020; 87: 7-12

Keywords
chronic kidney disease, hematopoietic stem cell transplantation, thrombotic microangiopathy, graft-versus-host disease

Correspondence to
Akiko Mii, MD, PhD, Department of Nephrology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
m-akiko@nms.ac.jp

Received, February 10, 2019
Accepted, August 23, 2019