Should we be performing more combined hematopoietic stem cell plus solid organ transplants?

Abstract

Summary:Both bone marrow and solid organ transplants (SOTs) can be life saving for a wide variety of diseases. We reviewed the literature and summarized the experiences of dual transplants. In total, 37 patients received a SOT for organ failure after a previous hematopoietic stem cell transplant. In all, 12 subjects received SOTs followed by a bone marrow transplant, while three patients received simultaneous SOTs and bone marrow transplants. Of these 52 patients, 37 were alive at the time of the original report at follow-up times ranging from 3 months to 8 years. A special registry for data collection may prove helpful for obtaining long-term follow-up data and providing outcome information that may improve future patient survival.

Nephrotic Syndrome after Hematopoietic Cell Transplantation

“…Prednisone was then stopped, and the patient's CKD progressed on an angiotensin-converting enzyme inhibitor. Ultimately, the patient may be a candidate for renal transplantation from her original bone marrow donor (10).…”

“…Electron microscopy showed focal areas of podocyte foot process effacement, and moderate fibrosis and tubular atrophy were seen in the interstitium. Currently, the patient has CKD stage 4, and he may receive a preemptive living-related donor kidney transplantation from his bone marrow donor in the future (10).…”

“…Prednisone was tapered, but in April 2004, the patient had a relapse of NS with peripheral edema, nephrotic-range proteinuria, and hypoalbuminemia. His prednisone dose was increased again to 1 mg/kg per d with excellent response, followed by a taper to 10 …”

Hematopoietic stem-cell transplantation following solid-organ transplantation in children

“…Reports of such interventions are published as case reports and use mainly living-related donors. 17 Chiang et al reviewed the outcome of four patients with leukemia/myelodysplastic syndrome (MDS) who received HSCT from living-related donors. Two patients survived at a follow-up of 7-22 months after receiving myeloablative conditioning regimen.…”

A Young Patient with Refractory Multiple Myeloma and Dialysis-Dependent Renal Failure has been Cured by Non-Cryopreserved Autologous Stem Cell Transplantation Followed by Live-Related Kidney Transplantation

“…Combined HSCT and SOT can be performed either simultaneously [59][60][61][62][63][64][65][66] or sequentially with either HSCT first followed by SOT [59,[67][68][69][70][71][72][73] or SOT first followed by HSCT [59,60,74,75]. Thus, patients with MM having ESRD, either on regular hemodialysis or not, can be offered not only HSCT but also combined HSCT and renal transplantation either simultaneously or sequentially [59,63,64,67,68].…”