The role of continuous renal replacement therapy in the management of acute kidney injury associated with sinusoidal obstruction syndrome following hematopoietic cell transplantation

Abstract

Maintaining fluid balance, preâ and postâ MAâ HCT is essential and usually requires frequent administration of diuretics. Hepatic sinusoidal obstructive syndrome is potentially lifeâ threatening, especially when associated with AKI and MOF. This study describes six patients who developed AKIâ associated SOS and diureticâ resistant FO who subsequently underwent CRRT using standardized management guidelines for fluid balance postâ HCT. Retrospective chart review was done for HCT patients between September 2011 and October 2013 at a tertiary care children’s hospital. Thirtyâ four patients underwent MAâ HCT in the study period. Six patients had SOS complicated by diureticâ resistant FO and underwent CRRT. Defibrotide was used in three patients. Median time on CRRT was 10.5Â days. Sixtyâ six percent (NÂ =Â 4 of 6) of patients had full resolution of SOS symptoms with a mortality rate of 34% (NÂ =Â 2 of 6). Among patients who had full recovery of SOS symptoms, one patient developed AKI, endâ stage renal diseases and underwent kidney transplantation 34â months postâ HCT. Thus, of six included patients, two died and one developed ESRD with only 50% (NÂ =Â 3 of 6) good outcome. Use of a standardized, evidenceâ based fluid balance protocol and early initiation of CRRT for HCTâ related AKI/SOS was associated with good outcomes.