Long-Term Effects of Kidney Shielding During Total Body Irradiation: A Single Institution Experience

Long-term follow-up of patients undergoing allogeneic hematopoietic stem-cell transplantation (HSCT) revealed a high incidence of chronic kidney disease (CKD), prompting us to introduce kidney shielding during total body irradiation (TBI) (kidney dose of 10 Gy).

To evaluate the effects of the shielding maneuver, we evaluated patients with acute lymphoblastic leukemia in first complete remission who had received allogeneic transplantation between 1990 and 2008. All patients had the same preparative regimen, with the exception of kidney shielding, which started in March 1999.

Seventy-two patients were included, 21 without shielding (GNS) and 51 with shielding (GS). The historical comparison led to more high-risk patients in the GS with regard to graft-versus-host disease. The incidence of acute GVHD graded more than II was higher in the GS (p=0.015), but this trend was not observed for chronic GVHD. The incidence of acute kidney injury diagnosed according to the RIFLE criteria was very similar in the two groups, whereas the incidence of CKD at 2 and 5 years after transplantation was significantly lower in the GS group (p=0.046). Five patients in the GNS developed renal failure that eventually required dialysis (9 to 17 years after transplantation), whereas no patients in the GS have required dialysis to date. The incidence of relapse demonstrated no significant differences between the two groups, irrespective of Philadelphia chromosomal status. There were no cases of relapse that started in the kidney or surrounding tissue. Overall survival was lower in the GS, but the difference was not statistically significant (p=0.286).

Protective shielding during TBI is able to suppress the incidence of CKD at 5 years after transplantation, without any significant effect on the risk of relapse.

No relevant conflicts of interest to declare.