Hematopoietic Cell Transplantation after Solid Organ Transplantation

Abstract

Solid organ transplantation (SOT) followed by hematopoietic cell transplantation (HCT) has been used to treat a single disease with multiorgan involvement or 2 separate diseases, the first requiring SOT and the second often a possible complication of SOT. Results of such serial transplants have been reported sporadically in the literature, usually as single case studies. Thirteen autologous and 27 allogeneic HCTs after SOT published previously are summarized. A more detailed review is provided for an additional 16 patients transplanted at a single institution, 8 of whom had autologous and 8 of whom had allogeneic HCT after SOT. Five of 8 autologous transplant recipients are alive a median of 4.6 years after HCT. Four of 8 allogeneic HCT recipients are alive a median of 8.7 years after HCT. In carefully selected patients, HCT after SOT is feasible and associated with a low incidence of either solid organ or hematopoietic cell rejection.

Sequential transplantation and implications for clinical management: OLT followed by HCT and consequent RT in a pediatric patient

“…Doney et al demonstrated that 85% of patients who underwent HCT after SOT for SAA were alive 0.5‐23 years after HCT. Irreversible rejection of the SOT after HCT (graft vs graft disease) is noted to be rare . Unfortunately, studies are still lacking regarding the strategy of immunosuppression during the progression of transplants—given reliance on case reports, a positive reporting bias likely exists, and morbidity and mortality may be higher than currently observed …”

“…It is unclear how the process of immune reconstitution and development of tolerance after HCT could affect a past and future SOT . Little data are available on the HLA constitution and compatibility of prior solid organ graft donors with hematopoietic cell donors and potential for “graft vs graft disease” . Thus far, in case reports available this has not seemed to be problematic .…”

A Young Patient with Refractory Multiple Myeloma and Dialysis-Dependent Renal Failure has been Cured by Non-Cryopreserved Autologous Stem Cell Transplantation Followed by Live-Related Kidney Transplantation

“…and leukemias as well as organ failure due to ESRD, liver failure or heart failure due to cardiomyopathies or other diseases [59][60][61][62]. Combined HSCT and SOT can be performed either simultaneously [59][60][61][62][63][64][65][66] or sequentially with either HSCT first followed by SOT [59,[67][68][69][70][71][72][73] or SOT first followed by HSCT [59,60,74,75].…”

“…Combined HSCT and SOT can be performed either simultaneously [59][60][61][62][63][64][65][66] or sequentially with either HSCT first followed by SOT [59,[67][68][69][70][71][72][73] or SOT first followed by HSCT [59,60,74,75]. Thus, patients with MM having ESRD, either on regular hemodialysis or not, can be offered not only HSCT but also combined HSCT and renal transplantation either simultaneously or sequentially [59,63,64,67,68].…”

Allogeneic transplantation of hematopoietic stem cells and solid organ in the same patient: an update

“…There were no significant differences in the outcomes between different types of HSCT donors or grafts, or the conditioning intensity. Doney et al [5] reported on eight patients who had received an allogeneic HSCT after SOT at their center. Four of the eight patients were alive after a median follow-up of 8.7 years post-transplantation.…”