This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. High-dose myeloablative therapy, followed by hematopoietic stem cell transplantation (HSCT), is an increasingly utilized treatment for many malignancies. Indeed, more than twenty thousand such HSCTs are now performed world-wide annually and offer the prospect of cures for otherwise fatal or incurable diseases. However, patient survival may be limited by substantial treatment-related toxicities. Among the most severe of these toxicities is renal dysfunction, which occurs frequently in the period immediately following HSCT. Renal insufficiency is also a major cause of morbidity in the first year post-transplant and beyond. Incidences of early acute renal insufficiency (occurring within 30-100 days post-transplant) are as high as 50%, while those for chronic kidney disease (occurring 6-12 months after transplant) range between 20-25% in adults and 11-62% in children. Mortality rates among patients with renal disease in this setting are significantly higher than transplant recipients who retain normal renal function, even when controlled for co-morbidity. Among those who progress to end-stage renal disease (ESRD) requiring dialysis, the mortality approaches 90%.
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