Prognostic Factors in Lung Transplantation after Hematopoietic Stem Cell Transplantation

Toyofumi F. Chen-Yoshikawa, Seiichiro Sugimoto, Takeshi Shiraishi, Masato Minami, Yasushi Matsuda, Masayuki Chida, Sumiko Maeda, Akihiro Aoyama, Yoshinori Okada, Meinoshin Okumura, Akinori Iwasaki, Shinichiro Miyoshi, Takahiro Oto, Hiroshi Date

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Abstract

Background Lung transplantation is the final lifesaving option for patients with pulmonary complications after hematopoietic stem cell transplantation (HSCT). Patients undergoing HSCT for hematologic diseases are thought to be high-risk candidates for lung transplantation; therefore, few lung transplants are performed for these patients, and few studies have been reported. This study aimed to describe the characteristics and outcomes of lung transplantation in patients with pulmonary complications after HSCT. Methods We retrospectively investigated 62 patients who underwent lung transplantation after HSCT. All data were collected from 6 lung transplant centers in Japan. Results Seventeen patients underwent cadaveric lung transplantation, whereas 45 underwent living-donor lobar lung transplantation (LDLLT). In the LDLLT group, 18 patients underwent LDLLT after HSCT in which one of the donors had also served as a donor for HSCT. Seven patients underwent single LDLLT for which the donor was the same as the patient from whom stem cells were obtained for HSCT. Preoperative hypercapnia was observed in 52 patients (84%). Thirteen patients (21%) required mechanical ventilation preoperatively. Fifty-five patients underwent HSCT for hematologic malignancies, and 4 (7%) relapsed after lung transplantation. The 5-year survival rate was 64.2%. In a multivariable analysis, patients younger than 45 years and those with the same donor for both procedures exhibited significantly better survival (P = 0.012 and 0.041, respectively). Conclusions Lung transplantation for pulmonary complications after HSCT was performed safely and yielded better survival, especially in younger recipients for whom both lung transplantation and HSCT involved the same donor.

Original languageEnglish
Pages (from-to)154-161
Number of pages8
JournalTransplantation
Volume102
Issue number1
DOIs
Publication statusPublished - 01-01-2018
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Transplantation

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    Chen-Yoshikawa, T. F., Sugimoto, S., Shiraishi, T., Minami, M., Matsuda, Y., Chida, M., Maeda, S., Aoyama, A., Okada, Y., Okumura, M., Iwasaki, A., Miyoshi, S., Oto, T., & Date, H. (2018). Prognostic Factors in Lung Transplantation after Hematopoietic Stem Cell Transplantation. Transplantation, 102(1), 154-161. https://doi.org/10.1097/TP.0000000000001886