eGFR Discordance and its Association with Outcomes following Allogeneic Hematopoietic Stem Cell Transplantation and Adoptive T-Cell Therapies

Authors

• Api Chewcharat
• Rajesh Anumolu
• Aditya Suresh
• Karla Sofia Yamada, The University of Texas Rio Grande Valley
• Jessica L. Ortega
• Ansh K. Mehta
• Kiana M. Zargari
• Mia B. Rubman
• Firasat M. Alikhan
• Zachariah DeFilipp

Document Type

Article

Publication Date

4-21-2026

Abstract

Background: Discordance between estimated glomerular filtration rate (eGFR) based on serum creatinine (eGFRcr) versus cystatin C (eGFRcys) is associated with adverse outcomes in patients with and without cancer. We hypothesized that eGFR discordance is associated with acute kidney injury (AKI) and death following hematopoietic stem cell transplant (HSCT) or receipt of adoptive T-cell therapies.

Methods: We conducted a multicenter study of adults receiving allogeneic HSCT and adoptive T-cell therapies who had paired serum creatinine and cystatin C values obtained in the 30 days preceding conditioning or lymphodepleting chemotherapy. The primary exposure was eGFR discordance, defined as eGFRcys ≥30% lower than eGFRcr. The primary outcome was a composite outcome of AKI (≥50% increase in serum creatinine or receipt of kidney replacement therapy) or death within 90 days following HSCT or adoptive T-cell infusion. Secondary outcomes included time-to-platelet engraftment in HSCT and prolonged cytopenia in adoptive T-cell recipients. We used multivariable logistic regression and cause-specific Cox regression with inverse probability weighting to adjust for confounders.

Results: Of 274 patients receiving HSCT (median age 65 years, interquartile range [IQR] 52-71]; 43% female), 86 (31%) had an eGFR discordance. Among 236 adoptive T-cell recipients (median age 67 years, IQR [60-74]; 59% female), 78 (33%) had a discordance in eGFR. eGFR discordance was associated with higher odds of AKI or death in HSCT (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.03-3.02) and adoptive T-cell recipients (OR 2.37; 95% CI 1.12-4.94). However, adjustment for eGFRcr-cys attenuated these associations in both cohorts. eGFR discordance was also associated with slower time-to-platelet engraftment in HSCT recipients and prolonged cytopenia following adoptive T-cell therapy.

Conclusions: A pre-treatment eGFR discordance was associated with AKI or death in HSCT and adoptive T-cell recipients; however, this association was attenuated after adjusting for eGFRcr-cys.

Comments

Copyright © 2026 by the American Society of Nephrology.

Recommended Citation

Chewcharat, A., Anumolu, R., Suresh, A., Yamada, K. S., Ortega, J. L., Mehta, A. K., Zargari, K. M., Rubman, M. B., Alikhan, F. M., DeFilipp, Z., Chowdhury, R. B., Jacobson, C. A., Nadeem, O., Soiffer, R. J., Leaf, D. E., Sise, M. E., Romee, R., Shapiro, R., & Gupta, S. (2026). eGFR Discordance and its Association with Outcomes following Allogeneic Hematopoietic Stem Cell Transplantation and Adoptive T-Cell Therapies. Journal of the American Society of Nephrology : JASN, 10.1681/ASN.0000001119. Advance online publication. https://doi.org/10.1681/ASN.0000001119    

Publication Title

Journal of the American Society of Nephrology

DOI

10.1681/ASN.0000001119

Academic Level

resident

Mentor/PI Department

Internal Medicine