Lung transplantation after allogeneic stem cell transplantation: a pan-European experience

Abstract

Late-onset noninfectious pulmonary complications (LONIPCs) affect 6% of allogeneic stem cell transplantation (SCT) recipients within 5 years, conferring subsequent 5-year survival of 50%. Lung transplantation is rarely performed in this setting due to concomitant extrapulmonary morbidity, excessive immunosuppression and concerns about recurring malignancy being considered contraindications. This study assesses survival in highly selected patients undergoing lung transplantation for LONIPCs after SCT.SCT patients undergoing lung transplantation at 20 European centres between 1996 and 2014 were included. Clinical data pre- and post-lung transplantation were reviewed. Propensity score-matched controls were generated from the Eurotransplant and Scandiatransplant registries. Kaplan-Meier survival analysis and Cox proportional hazard regression models evaluating predictors of graft loss were performed.Graft survival at 1, 3 and 5 years of 84%, 72% and 67%, respectively, among the 105 SCT patients proved comparable to controls (p=0.75). Sepsis accounted for 15 out of 37 deaths (41%), with prior mechanical ventilation (HR 6.9, 95% CI 1.0-46.7; p<0.001) the leading risk factor. No SCT-specific risk factors were identified. Recurring malignancy occurred in four patients (4%). Lung transplantation <2 years post-SCT increased all-cause 1-year mortality (HR 7.5, 95% CI 2.3-23.8; p=0.001).Lung transplantation outcomes following SCT were comparable to other end-stage diseases. Lung transplantation should be considered feasible in selected candidates. No SCT-specific factors influencing outcome were identified within this carefully selected patient cohort.

Noninfectious pulmonary complications of haematopoietic stem cell transplantation

“…Recurring malignancy was reported in only 4% patients. Sepsis accounted for 41% deaths in the cohort and lung transplantation within 2 years of HSCT was also associated with increased 1-year all-cause mortality [118].…”

A bi‐centric experience of extracorporeal carbon dioxide removal (ECCO2R) for acute hypercapnic respiratory failure following allogeneic hematopoietic stem cell transplantation

“… 28 This circumstance might also apply to patients with chronic GVHD and lung involvement, as the underlying lung pathology might be too severe or irreversible. Of note, several large cohort studies have proven the feasibility of lung transplantation following HSCT, 29 but so far, none have addressed bridging with extracorporeal life‐support in these patients. It is noteworthy that three of our patients had pneumonia caused by P. jirovecii , a pathogen that by itself induces or aggravates bronchiolitis.…”

Phenotypical diversity of airway morphology in chronic lung graft vs. host disease after stem cell transplantation

“…Within allogenic hematopoietic stem cell transplantation, the number of graft vs. host disease lungs available for research is limited by the low incidence of lung graft vs. host disease, the difficulty to negotiate an autopsy with grieving families and the low number of chronic graft vs. host disease patients making it to lung transplantation. In fact, a recent study evaluating survival post lung transplantation in 20 European lung transplant centers over a 18-year period included 105 allogenic hematopoietic stem cell transplantation patients, the largest series described so far [29]. Therefore, the six patients included already represent a significant number.…”