Feasibility and outcomes of kidney transplantation in patients with end-stage kidney disease after haemopoietic stem cell transplantation

Background: Advances in haemopoietic stem cell transplantation (HSCT) have improved long-term survival, but they have also led to late complications, such as nephropathy. However, the safety and feasibility of kidney transplantation (KT) in patients with HSCT-related end-stage kidney disease (ESKD) remain unclear. Aim: This study aimed to evaluate the feasibility and clinical outcomes of KT in patients with ESKD following HSCT. Methods: This study retrospectively analysed eight patients with ESKD who underwent KT following HSCT for haematologic disorders, including aplastic anaemia (n = 5), acute myeloid leukaemia (n = 2) and chronic myeloid leukaemia (n = 1). Results: The median time to progression to ESKD was 104 months after HSCT, with a median interval of 138 months between HSCT and KT. The causes of ESKD included diabetic nephropathy (n = 1), hypertensive nephropathy (n = 1), focal segmental glomerulosclerosis (n = 1), thrombotic microangiopathy (n = 1) and unknown aetiology (n = 4), with three diagnoses confirmed through kidney biopsy. Three patients received both HSCT and KT from the same donor, allowing them to completely discontinue immunosuppressive therapy. During a median follow-up of 55 months (range 2–143 months), there was only one case of acute T-cell-mediated rejection, and one patient died from sepsis due to a urinary tract infection. Notably, none of the patients experienced a recurrence of their original haematologic disease. Conclusion: Despite concerns regarding immunosuppression and the risk of infection in this high-risk population, both patient and graft outcomes were favourable. These findings suggest that KT is a feasible and effective treatment option for patients with ESKD following HSCT, particularly when managed with personalised strategies.