Clinical Characteristics and Prognostic Factors of Nephrotic Syndrome after Allogeneic Hematopoietic Stem Cell Transplantation

Aims/Background Although the incidence of nephrotic syndrome (NS) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) is relatively low, it can significantly affect patients' quality of life and may even be life-threatening. Therefore, it is essential to investigate the clinical manifestations and prognosis of patients with NS after allo-HSCT, as well as to identify potential high-risk factors associated with this condition. Methods We investigated the incidence rate of NS in 1457 patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) at the First Affiliated Hospital, Zhejiang University School of Medicine between June 2007 and March 2020. Among these, we identified 12 patients who developed NS after allo-HSCT (NS group). For comparison, we selected a control group of 48 patients matched by gender and transplantation time who did not develop NS. Univariate and multivariate logistic regression analyses were performed using SPSS software, version 25.0 (IBM Corp., Armonk, NY, USA) to identify independent risk factors for NS. Results Among the 1457 patients, 12 (0.82%) developed post-transplantation NS, with a median onset time of 14.99 months (range: 5.39-48.43 months) after transplantation. Univariate analysis indicated that the occurrence of post-transplantation NS was significantly correlated with total cholesterol (TC) levels at 6 months post-transplantation (p = 0.041), triglycerides (TG) and TC levels at 1 year post- transplantation (p = 0.004 and p = 0.011, respectively), and cytomegalovirus (CMV) infection (p = 0.002). Multivariate analysis revealed that CMV infection (p = 0.004, odds ratio = 15.871; 95% confidence interval: 2.465-102.194) was independently associated with the development of NS. Conclusion After allo-HSCT, NS may manifest as a form of chronic graft-versus-host disease. CMV infection is a risk factor for developing NS. Effective management through the administration of calcium inhibitors and corticosteroids can enable long-term survival in these patients.