In-hospital complications and outcomes of autologous stem cell transplantation in diffuse large B-cell lymphoma with and without chronic kidney disease.

Abstract

e19109 Background: Chronic kidney disease (CKD) may increase transplant-related toxicity during autologous stem cell transplantation (autoSCT) for diffuse large B-cell lymphoma (DLBCL). Contemporary national inpatient outcomes data for this subgroup are limited. Methods: We performed a retrospective cohort study using the 2022 National Inpatient Sample (NIS), which includes ~20% of U.S. hospital discharges. Adults (≥18 years) hospitalized with DLBCL who underwent bone marrow transplant/autoSCT were identified using ICD-10-CM/PCS codes and stratified by secondary diagnosis of CKD. Multivariable logistic regression was used for categorical outcomes and linear regression for continuous outcomes (length of stay [LOS], total hospitalization charges), adjusting for age, sex, race, Elixhauser comorbidity score, insurance status, and hospital characteristics. Results: We identified 1,025 DLBCL autoSCT hospitalizations; 80 (7.8%) had CKD. Mean age was 59.8 vs 58.6 years (p=0.63) and 68.8% vs 52.4% were male (p=0.21) in the CKD vs non-CKD cohorts. CKD was independently associated with higher AKI (56.25% vs 11.11%; adjusted OR [aOR] 8.48, 95% CI 1.88–38.1; p=0.005). Differences were not statistically significant for AKI requiring HD (6.25% vs 1.59%; aOR 4.76, 95% CI 0.41–55.2; p=0.21), septic shock (6.25% vs 3.70%; aOR 3.92, 95% CI 0.44–34.9; p=0.22), in-hospital mortality (6.25% vs 4.23%; aOR 1.41, 95% CI 0.20–9.7; p=0.72), or intubation (6.25% vs 1.40%; aOR 0.32, 95% CI 0.04–2.07; p=0.23). Mean total charges were $100,488 lower and mean LOS 2.9 days shorter in the CKD cohort versus non-CKD; however, neither difference was statistically significant. Conclusions: In a national inpatient cohort of DLBCL hospitalizations undergoing autoSCT, pre-existing CKD was independently associated with a markedly higher risk of AKI, highlighting renal vulnerability during transplant admission. In contrast, differences in AKI requiring HD, septic shock, intubation, LOS, charges, and in-hospital mortality were not statistically significant after adjustment. Taken together, these findings emphasize the need for heightened vigilance for AKI in high-risk patients with CKD. It supports proactive peri-transplant renal risk mitigation, including optimizing fluid management and medication review to minimize AKI development.