Intensive care risk and long-term outcomes in pediatric allogeneic hematopoietic cell transplant recipients

• DOI: 10.1182/bloodadvances.2023011002
• Publication Date: 2023-12-21T16:07:18Z
• Authors: Matt S. Zinter; Ruta Brazauskas; Joelle Strom; Stella Chen; Stephanie Bo-Subait; Akshay Sharma; Amer Beitinjaneh; Dimana Dimitrova; Greg Guilcher; Jaime Preussler; Kasiani Myers; Neel S. Bhatt; Olle Ringden; Peiman Hematti; Robert J. Hayashi; Sagar Patel; Satiro Nakamura D...; Seth Rotz; Sherif M. Badawy; Taiga Nishihori; David Buchbinder; Betty Hamilton; Bipin Savani; Hélène Schoemans; Mohamed Sorror; Lena Winestone; Christine Duncan; Rachel Phelan; Christopher C. Dv...
• Keywords: Homologous; Critical Care; 610; Graft vs Host Disease; CHILDREN; MORBIDITY; 616; Medicine and Health Sciences; Humans; Transplantation, Homologous; Child; Transplantation; Science & Technology; MORTALITY; ICTS (Institute of Clinical and Translational Sciences); Hematopoietic Stem Cell Transplantation; Hematology; ONCOLOGY; ADMISSION; TRENDS; United States; Transplant Recipients; SEVERE SEPSIS; LUNG-FUNCTION; INSIGHTS; UNIT; Life Sciences & Biomedicine

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