What question did this study set out to answer?

The study aims to estimate morbidity and mortality rates in children with severe sinusoidal obstructive syndrome receiving continuous kidney replacement therapy.

March 26, 2026

1337: Continuous Kidney Replacement Therapy in Pediatric Sos: A Single-Center Experience

Puntos clave

The study aims to estimate morbidity and mortality rates in children with severe sinusoidal obstructive syndrome receiving continuous kidney replacement therapy.
Conducted a single-center retrospective analysis at Phoenix Children’s Hospital
Included pediatric HSCT patients aged 0-21 with SOS and acute kidney injury admitted to the PICU for CKRT
Classified SOS severity using EBMT grading and AKI using KDIGO classification
Measured fluid overload percentages using weight and fluid input/output calculations
68% of patients admitted for CKRT had severe or very severe SOS
Overall mortality rate was 24% among those receiving CKRT
No significant differences in survival based on early vs late CKRT initiation post-SOS diagnosis
Survivors had a median CKRT duration of 8.2 days and a fluid overload percentage of 9.3% at CKRT initiation
Significant differences in days of mechanical ventilation and PICU length of stay between survivors and non-survivors

Resumen

Introduction: Severe cases of sinusoidal obstructive syndrome (SOS) after hematopoietic stem cell transplant (HSCT) often require continuous kidney replacement therapy (CKRT) to manage fluid overload (FO). Pediatric studies are limited in assessing outcomes of critically ill children with severe SOS and CKRT. This study is aimed at estimating morbidity and mortality in patients with SOS receiving CKRT for fluid overload (FO) and acute kidney injury (AKI). Methods: This is a single-center retrospective study conducted at Phoenix Children’s Hospital to analyze demographics, pre-transplant factors, and post-transplant complications in pediatric HSCT patients aged 0-21 years, with SOS and AKI admitted to the pediatric intensive care unit (PICU) for CKRT from January 2015 to December 2024. The SOS severity was classified using European bone marrow transplant (EBMT) severity grading, AKI using KDIGO (Kidney Disease: Improving Global Outcomes) classification, and the percent of fluid overload was measured using (%FO (weight) = (weight − admit weight × admit weight−1) × 100 or %FO (input/output) = (total fluid input in liters − total fluid output in liters × admit weight−1) × 100. The primary outcome was mortality, and the secondary outcomes were morbidity estimates (PICU length of stay or LOS, duration of mechanical ventilation, use of vasoactive support). Results: A total of 31 patients developed SOS, and 21/31 (68%) developed severe or very severe SOS requiring PICU admission and CKRT. Overall mortality was 5/21 (24%). There was no significant difference between survivors and non-survivors between early (24 hours) CKRT initiation post-SOS diagnosis. Median CKRT days among survivors was 8.2 (6.4-20.3) and %FO at initiation of CKRT 9.3 (5.5-11). Days of mechanical ventilation and PICU LOS were significantly different between survivors and non-survivors. Conclusions: In this study of post-HSCT children with SOS who received CKRT, 76% survived to ICU discharge. Our institution reports a higher survival rate for pediatric SOS with the use of CKRT, compared to what has been reported in the literature for this cohort.

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Cite This Study

Kharayat et al. (Sun,) studied this question.

synapsesocial.com/papers/69c4cd05fdc3bde448918cb4 https://doi.org/https://doi.org/10.1097/01.ccm.0001187344.97881.03

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