Lung transplantation after allogeneic stem cell transplantation: a pan-European experience.
Details
Serval ID
serval:BIB_106729F6283A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Lung transplantation after allogeneic stem cell transplantation: a pan-European experience.
Journal
The European respiratory journal
ISSN
1399-3003 (Electronic)
ISSN-L
0903-1936
Publication state
Published
Issued date
02/2018
Peer-reviewed
Oui
Volume
51
Number
2
Pages
NA
Language
english
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: epublish
Publication Status: epublish
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.
Keywords
Adult, Europe, Female, Graft Survival, Humans, Immunosuppressive Agents, Kaplan-Meier Estimate, Lung Transplantation/methods, Male, Phenotype, Propensity Score, Proportional Hazards Models, Registries, Regression Analysis, Reoperation, Retrospective Studies, Risk Factors, Sepsis/complications, Sepsis/mortality, Spirometry, Stem Cell Transplantation/methods, Transplantation, Homologous, Treatment Outcome, Young Adult
Pubmed
Web of science
Create date
01/03/2018 21:24
Last modification date
20/08/2019 12:37