Faculty Collaboration Database

Intensive care risk and long-term outcomes in pediatric allogeneic hematopoietic cell transplant recipients. Blood Adv 2024 Feb 27;8(4):1002-1017

Date

12/21/2023

Pubmed ID

38127268

Pubmed Central ID

PMC10879681

DOI

10.1182/bloodadvances.2023011002

Scopus ID

2-s2.0-85187724652 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

Allogeneic hematopoietic cell transplantation (HCT) can be complicated by life-threatening organ toxicity and infection necessitating intensive care. Epidemiologic data have been limited by single-center studies, poor database granularity, and a lack of long-term survivors. To identify contemporary trends in intensive care unit (ICU) use and long-term outcomes, we merged data from the Center for International Blood and Marrow Transplant Research and the Virtual Pediatric Systems databases. We identified 6995 pediatric patients with HCT aged ≤21 years who underwent first allogeneic HCT between 2008 and 2014 across 69 centers in the United States or Canada and followed patients until the year 2020. ICU admission was required for 1067 patients (8.3% by day +100, 12.8% by 1 year, and 15.3% by 5 years after HCT), and was linked to demographic background, pretransplant organ toxicity, allograft type and HLA-match, and the development of graft-versus-host disease or malignancy relapse. Survival to ICU discharge was 85.7%, but more than half of ICU survivors required ICU readmission, leading to 52.5% and 42.6% survival at 1- and 5-years post-ICU transfer, respectively. ICU survival was worse among patients with malignant disease, poor pretransplant organ function, and alloreactivity risk factors. Among 1-year HCT survivors, those who required ICU in the first year had 10% lower survival at 5 years and developed new dialysis-dependent renal failure at a greater rate (P<.001). Thus, although ICU management is common and survival to ICU discharge is high, ongoing complications necessitate recurrent ICU admission and lead to a poor 1-year outcome in select patients who are at high risk.

Author List

Zinter MS, Brazauskas R, Strom J, Chen S, Bo-Subait S, Sharma A, Beitinjaneh A, Dimitrova D, Guilcher G, Preussler J, Myers K, Bhatt NS, Ringden O, Hematti P, Hayashi RJ, Patel S, De Oliveira SN, Rotz S, Badawy SM, Nishihori T, Buchbinder D, Hamilton B, Savani B, Schoemans H, Sorror M, Winestone L, Duncan C, Phelan R, Dvorak CC

Authors

Ruta Brazauskas PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Peiman Hematti MD Professor in the Medicine department at Medical College of Wisconsin
Rachel A. Phelan MD, MPH Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Child
Critical Care
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Transplant Recipients
Transplantation, Homologous
United States