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Eur Respir J. 2018 Feb 14;51(2). pii: 1701330. doi: 10.1183/13993003.01330-2017. Print 2018 Feb.

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

Author information

1
Hannover Medical School, Hannover, Germany greer.mark@mh-hannover.de.
2
Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research (DZL), Hannover, Germany.
3
University Hospital Vall d'Hebron, Barcelona, Spain.
4
Medical University of Vienna, Vienna, Austria.
5
University Hospital Zurich, Zurich, Switzerland.
6
University Hospital Lausanne, Lausanne, Switzerland.
7
Hospital Foch, Suresnes, France.
8
Hospital Bichat, Paris, France.
9
Civil Hospital, University of Strasbourg, Strasbourg, France.
10
University North Hospital, Aix Marseille University, Marseille, France.
11
Hospices Civils de Lyon, Lyon, France.
12
University Hospital Grenoble, Grenoble, France.
13
Erasme University Hospital, Brussels, Belgium.
14
University Hospitals Leuven, Leuven, Belgium.
15
University Medical Center, University of Groningen, Groningen, The Netherlands.
16
Institute of Transplantation, Freeman Hospital and Newcastle University, Newcastle upon Tyne, UK.
17
Sahlgrenska University Hospital, Gothenburg, Sweden.
18
Skåne University Hospital, Lund, Sweden.
19
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
20
Helsinki University Hospital, Helsinki, Finland.
21
Dept of Health Metrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
22
Eurotransplant Foundation, Leiden, The Netherlands.
23
Hannover Medical School, Hannover, Germany.
24
Oslo University Hospital Rikshospitalet, Oslo, Norway.
25
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
26
Scandiatransplant, Aarhus, Denmark.

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.

Conflict of interest statement

Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com

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