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

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.