TITLE

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

AUTHOR(S)
Schechter-Finkelstein, T; Gassas, A; Weitzman, S; Grant, D; Pollock-BarZiv, S; Dipchand, A; Alexander, S; Ali, M; Avitzur, Y; Doyle, J
PUB. DATE
October 2011
SOURCE
Bone Marrow Transplantation;Oct2011, Vol. 46 Issue 10, p1321
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Reports of hematopoietic stem-cell transplantation (HSCT) following solid-organ transplantation have been described in adults mainly as case reports. These reports demonstrate feasibility but likely do not reflect true outcomes due to a positive reporting bias. We report herein the outcomes of all our pediatric recipients of allogeneic HSCT following previous solid-organ transplantation between 2000 and 2009. Four children were identified. Two patients underwent heart transplantation followed by cord-blood allogeneic HSCT for T-cell lymphoma/post transplant lymphoproliferative disease (PTLD) and two patients underwent liver transplantation followed by living-donor allogeneic HSCT for severe aplastic anemia (SAA). The mean time between transplants was 4.2 years (range 1.5-6 years). All patients engrafted; however, all patients died from 37 days to 1 year after HSCT. Causes of death included infections (n=2), multi-organ failure (n=1) and solid-organ graft rejection (n=1). Though three patients survived beyond day+100, multiple complications were observed including EBV re-activation followed by EBV-positive PTLD (n=1) and five episodes of severe infections. The patients transplanted for lymphoma did not have evidence of recurrence at last follow-up. Although feasibilty has been shown with this cohort, we conclude that allogeneic HSCT in immunosuppressed patients following solid-organ transplantation remains a very high risk procedure that results in severe morbidity and mortality in children.
ACCESSION #
66445268

 

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