1. Lung transplantation after allogeneic stem cell transplantation: a pan-European experience
- Author
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Christian Benden, Are Martin Holm, Mark Greer, Johanna Claustre, Erik A M Verschuuren, Martine Reynaud-Gaubert, Cristina Berastegui, Lennart Hansson, Jens Gottlieb, Jacqueline M. Smits, Hans Wedel, Pekka Hämmäinen, François Philit, Marc Stern, Martin Iversen, Peter Jaksch, J.-D. Aubert, Andrew J. Fisher, Pierre LePalud, Robin Vos, Gerdt C. Riise, Elodie Lhuillier, Antoine Roux, Christiane Knoop, Sandrine Hirschi, University of Zurich, Greer, Mark, Division Pulmonary Medicine, University hospital of Zurich [Zurich], Laboratoire de recherche sur les mécanismes moléculaires et pharmacologiques de l’obstruction bronchique (LOBIP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de pneumologie (Strasbourg), CHU Strasbourg-Nouvel Hôpital Civil, Microbes évolution phylogénie et infections (MEPHI), Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Centre de Référence des Maladies Pulmonaires Rares [Hôpital Louis Pradel - HCL], Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Clinique Universitaire de Pneumologie, Pôle Thorax et Vaisseaux, Centre Hospitalier Universitaire de Grenoble, Service de pneumologie [Hôpital Foch], Hôpital Foch [Suresnes], Department of Chest Medicine, Mont-Godinne Hospital-Catholic University of Louvain de Mont-Godinne, Nordic School of Public Health, SAP Research (SAP Research), Groningen Institute for Organ Transplantation (GIOT), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire [Grenoble] (CHU), Department of Surgery, III kirurgian klinikka, Clinicum, and HUS Heart and Lung Center
- Subjects
Male ,medicine.medical_treatment ,CHILDREN ,Kaplan-Meier Estimate ,0302 clinical medicine ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Risk Factors ,VERSUS-HOST-DISEASE ,Medicine ,CRITERIA ,Registries ,Graft Survival ,Immunosuppression ,Europe ,surgical procedures, operative ,Phenotype ,Treatment Outcome ,030220 oncology & carcinogenesis ,Cohort ,Regression Analysis ,Female ,10178 Clinic for Pneumology ,Immunosuppressive Agents ,Lung Transplantation ,Pulmonary and Respiratory Medicine ,Adult ,Reoperation ,medicine.medical_specialty ,INTERNATIONAL SOCIETY ,610 Medicine & health ,Malignancy ,03 medical and health sciences ,Young Adult ,BRONCHIOLITIS-OBLITERANS-SYNDROME ,Internal medicine ,Sepsis ,Lung transplantation ,Humans ,Transplantation, Homologous ,Risk factor ,Propensity Score ,Survival analysis ,ACUTE LYMPHOBLASTIC-LEUKEMIA ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,MORTALITY ,3126 Surgery, anesthesiology, intensive care, radiology ,medicine.disease ,Transplantation ,ALLOGRAFT DYSFUNCTION ,Spirometry ,2740 Pulmonary and Respiratory Medicine ,3121 General medicine, internal medicine and other clinical medicine ,Concomitant ,UPDATE ,ALLO-SCT ,business ,030215 immunology ,Stem Cell Transplantation - 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; pLung 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.
- Published
- 2018
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