147 - Single-center experience of pediatric post-hematopoietic stem cell transplant patients with sinusoidal obstructive syndrome requiring continuous renal replacement therapy: A retrospective study.

Publication Number: 2141.147

Clayton Long, Phoenix Children's Hospital, Scottsdale, AZ, United States; Priyanka Kharayat, University of Mississippi Medical Center, Madison, MS, United States; Roberta H. Adams, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States; Karen Papez, Phoenix Children's Hospital, Phoenix, AZ, United States; Joshua Zaritsky, Phoenix children's hospital, Phoenix, AZ, United States; Vishal Gunnala, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: Sinusoidal obstructive syndrome (SOS) is a serious complication after hematopoietic stem cell transplant (HSCT) and has high mortality. Severe cases of SOS often require continuous renal replacement therapy (CRRT) to manage fluid overload (FO). Pediatric studies are limited in assessing outcomes of critically ill children with severe SOS and CRRT.

Objective: This study is aimed at estimating morbidity and mortality in patients with SOS receiving CRRT for fluid overload (FO) and AKI.

Design/Methods: This is a single-center retrospective study conducted at Phoenix Children’s Hospital, using patient chart review to analyze demographics, pre-transplant factors, and post-transplant complications in pediatric hematopoietic stem cell transplant patients aged 0-21 years, with SOS and AKI admitted to the pediatric intensive care unit (PICU) for CRRT from January 1st, 2015, to December 31st, 2024. The SOS criteria implemented with European bone marrow transplant (EBMT) severity grading, AKI using KDIGO (Kidney Disease: Improving Global Outcomes) classification, and the percent of fluid overload (%FO (weight) = ([weight − admit weight] × [admit weight]−1) × 100 or %FO (input/output) = ([total fluid input in liters − total fluid output in liters] × [admit weight]−1) × 100. The primary outcomes were mortality, and the secondary outcomes were morbidity estimates (PICU length of stay or LOS, duration of mechanical ventilation, use of vasoactive support).

Results: A total of 31 patients developed SOS post HSCT, and 21/31 (68%) developed severe or very severe SOS requiring PICU admission and CRRT. Overall mortality was 5/21 (24%). There was no significant difference between survivors and non-survivors between early ( < 24 hours) vs late (>24 hours) CRRT initiation post-SOS diagnosis. Median (Q1-Q3) CRRT days among survivors was 8.2 (6.4-20.3) and %FO at initiation of CRRT 9.3 (5.5-11). Days of mechanical ventilation and PICU LOS were significantly different between survivors and non-survivors.

Conclusion(s): In this study of post-HSCT children with SOS and who received CRRT, 76% survived until ICU discharge. Our institution reports a higher survival rate for SOS and CRRT compared to general pediatric cohorts treated with CRRT.

Table 1 Demographics
Table 1 Demographics.pdfThere were no statistical differences in demographics between survivors and non-survivors.

Table 2 Results
Table 2 Results.pdfDays of mechanical ventilation and PICU length of stay were significantly different between survivors and non-survivors