Lung transplantation after hematopoietic stem cell transplantation

Bryan A. Whitson, Ryan C. Shelstad, Marshall I Hertz, Rosemary F Kelly, Jonathan D'Cunha, Sara J Shumway

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction: Pulmonary insufficiency following bone marrow transplant (BMT) is common and has significant associated mortality. Lung transplantation (LTX) is the only viable treatment for patients with end-stage pulmonary disease, but LTX after BMT is an uncommon event given the medical candidacy of the potential recipients. We sought to evaluate the short- and long-term outcomes of LTX in BMT recipients. Methods: We performed a retrospective evaluation of our institution's longitudinal LTX and BMT databases. Demographic and outcomes variables were collected. Results: We identified 639 LTX from January 1, 1988, through December 31, 2009, and 5525 BMT from program inception, March 21, 1974, through December 31, 2009. From the cross-referenced cohort, we identified four patients who had BMT followed by LTX. Our series was composed of two men and two women, with a mean age of 32.3yr (range, 20-59yr). Single LTX were performed in two recipients (50%). All patients had significant and expected morbidities related to their transplant immunosuppression. Three patients (75%) required cardiopulmonary bypass at the time of LTX. The two recipients who underwent bilateral LTX required open chest management and subsequent tracheostomy. All patients are still alive at follow-up (range, 19-119months, median 39.5). Conclusion: Our study demonstrates that LTX in the setting of BMT is a high-risk operation with the potential for a tumultuous perioperative course. Despite this, good outcomes and survival are obtainable in carefully selected patients. Selection factors include clinically stable patients without active sepsis and preoperative optimization of nutrition in anticipation of a prolonged recovery. An experienced multidisciplinary team approach and a protocol-driven management plan are paramount for successful outcomes in this challenging population.

Original languageEnglish (US)
Pages (from-to)254-258
Number of pages5
JournalClinical Transplantation
Volume26
Issue number2
DOIs
StatePublished - Mar 1 2012

Fingerprint

Lung Transplantation
Hematopoietic Stem Cell Transplantation
Bone Marrow
Transplants
Tracheostomy
Cardiopulmonary Bypass
Immunosuppression
Lung Diseases
Sepsis
Thorax
Demography
Databases
Morbidity
Lung
Survival
Mortality
Population

Keywords

  • Bone marrow transplant
  • Lung transplantation
  • Pulmonary fibrosis

Cite this

Lung transplantation after hematopoietic stem cell transplantation. / Whitson, Bryan A.; Shelstad, Ryan C.; Hertz, Marshall I; Kelly, Rosemary F; D'Cunha, Jonathan; Shumway, Sara J.

In: Clinical Transplantation, Vol. 26, No. 2, 01.03.2012, p. 254-258.

Research output: Contribution to journalArticle

Whitson, Bryan A. ; Shelstad, Ryan C. ; Hertz, Marshall I ; Kelly, Rosemary F ; D'Cunha, Jonathan ; Shumway, Sara J. / Lung transplantation after hematopoietic stem cell transplantation. In: Clinical Transplantation. 2012 ; Vol. 26, No. 2. pp. 254-258.
@article{c9635722b3cb47b381803c6d9eed0a95,
title = "Lung transplantation after hematopoietic stem cell transplantation",
abstract = "Introduction: Pulmonary insufficiency following bone marrow transplant (BMT) is common and has significant associated mortality. Lung transplantation (LTX) is the only viable treatment for patients with end-stage pulmonary disease, but LTX after BMT is an uncommon event given the medical candidacy of the potential recipients. We sought to evaluate the short- and long-term outcomes of LTX in BMT recipients. Methods: We performed a retrospective evaluation of our institution's longitudinal LTX and BMT databases. Demographic and outcomes variables were collected. Results: We identified 639 LTX from January 1, 1988, through December 31, 2009, and 5525 BMT from program inception, March 21, 1974, through December 31, 2009. From the cross-referenced cohort, we identified four patients who had BMT followed by LTX. Our series was composed of two men and two women, with a mean age of 32.3yr (range, 20-59yr). Single LTX were performed in two recipients (50{\%}). All patients had significant and expected morbidities related to their transplant immunosuppression. Three patients (75{\%}) required cardiopulmonary bypass at the time of LTX. The two recipients who underwent bilateral LTX required open chest management and subsequent tracheostomy. All patients are still alive at follow-up (range, 19-119months, median 39.5). Conclusion: Our study demonstrates that LTX in the setting of BMT is a high-risk operation with the potential for a tumultuous perioperative course. Despite this, good outcomes and survival are obtainable in carefully selected patients. Selection factors include clinically stable patients without active sepsis and preoperative optimization of nutrition in anticipation of a prolonged recovery. An experienced multidisciplinary team approach and a protocol-driven management plan are paramount for successful outcomes in this challenging population.",
keywords = "Bone marrow transplant, Lung transplantation, Pulmonary fibrosis",
author = "Whitson, {Bryan A.} and Shelstad, {Ryan C.} and Hertz, {Marshall I} and Kelly, {Rosemary F} and Jonathan D'Cunha and Shumway, {Sara J}",
year = "2012",
month = "3",
day = "1",
doi = "10.1111/j.1399-0012.2011.01482.x",
language = "English (US)",
volume = "26",
pages = "254--258",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Lung transplantation after hematopoietic stem cell transplantation

AU - Whitson, Bryan A.

AU - Shelstad, Ryan C.

AU - Hertz, Marshall I

AU - Kelly, Rosemary F

AU - D'Cunha, Jonathan

AU - Shumway, Sara J

PY - 2012/3/1

Y1 - 2012/3/1

N2 - Introduction: Pulmonary insufficiency following bone marrow transplant (BMT) is common and has significant associated mortality. Lung transplantation (LTX) is the only viable treatment for patients with end-stage pulmonary disease, but LTX after BMT is an uncommon event given the medical candidacy of the potential recipients. We sought to evaluate the short- and long-term outcomes of LTX in BMT recipients. Methods: We performed a retrospective evaluation of our institution's longitudinal LTX and BMT databases. Demographic and outcomes variables were collected. Results: We identified 639 LTX from January 1, 1988, through December 31, 2009, and 5525 BMT from program inception, March 21, 1974, through December 31, 2009. From the cross-referenced cohort, we identified four patients who had BMT followed by LTX. Our series was composed of two men and two women, with a mean age of 32.3yr (range, 20-59yr). Single LTX were performed in two recipients (50%). All patients had significant and expected morbidities related to their transplant immunosuppression. Three patients (75%) required cardiopulmonary bypass at the time of LTX. The two recipients who underwent bilateral LTX required open chest management and subsequent tracheostomy. All patients are still alive at follow-up (range, 19-119months, median 39.5). Conclusion: Our study demonstrates that LTX in the setting of BMT is a high-risk operation with the potential for a tumultuous perioperative course. Despite this, good outcomes and survival are obtainable in carefully selected patients. Selection factors include clinically stable patients without active sepsis and preoperative optimization of nutrition in anticipation of a prolonged recovery. An experienced multidisciplinary team approach and a protocol-driven management plan are paramount for successful outcomes in this challenging population.

AB - Introduction: Pulmonary insufficiency following bone marrow transplant (BMT) is common and has significant associated mortality. Lung transplantation (LTX) is the only viable treatment for patients with end-stage pulmonary disease, but LTX after BMT is an uncommon event given the medical candidacy of the potential recipients. We sought to evaluate the short- and long-term outcomes of LTX in BMT recipients. Methods: We performed a retrospective evaluation of our institution's longitudinal LTX and BMT databases. Demographic and outcomes variables were collected. Results: We identified 639 LTX from January 1, 1988, through December 31, 2009, and 5525 BMT from program inception, March 21, 1974, through December 31, 2009. From the cross-referenced cohort, we identified four patients who had BMT followed by LTX. Our series was composed of two men and two women, with a mean age of 32.3yr (range, 20-59yr). Single LTX were performed in two recipients (50%). All patients had significant and expected morbidities related to their transplant immunosuppression. Three patients (75%) required cardiopulmonary bypass at the time of LTX. The two recipients who underwent bilateral LTX required open chest management and subsequent tracheostomy. All patients are still alive at follow-up (range, 19-119months, median 39.5). Conclusion: Our study demonstrates that LTX in the setting of BMT is a high-risk operation with the potential for a tumultuous perioperative course. Despite this, good outcomes and survival are obtainable in carefully selected patients. Selection factors include clinically stable patients without active sepsis and preoperative optimization of nutrition in anticipation of a prolonged recovery. An experienced multidisciplinary team approach and a protocol-driven management plan are paramount for successful outcomes in this challenging population.

KW - Bone marrow transplant

KW - Lung transplantation

KW - Pulmonary fibrosis

UR - http://www.scopus.com/inward/record.url?scp=84859809620&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84859809620&partnerID=8YFLogxK

U2 - 10.1111/j.1399-0012.2011.01482.x

DO - 10.1111/j.1399-0012.2011.01482.x

M3 - Article

C2 - 21585549

AN - SCOPUS:84859809620

VL - 26

SP - 254

EP - 258

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

IS - 2

ER -