title: Hematopoietic stem-cell transplantation following solid-organ transplantation in children.
abstract: Reports of hematopoietic stem-cell transplantation (HSCT) following solid-organ transplantation have been described in adults mainly as case reports. These reports demonstrate feasibility but likely do not reflect true outcomes due to a positive reporting bias. We report herein the outcomes of all our pediatric recipients of allogeneic HSCT following previous solid-organ transplantation between 2000 and 2009. Four children were identified. Two patients underwent heart transplantation followed by cord-blood allogeneic HSCT for T-cell lymphoma/post transplant lymphoproliferative disease (PTLD) and two patients underwent liver transplantation followed by living-donor allogeneic HSCT for severe aplastic anemia (SAA). The mean time between transplants was 4.2 years (range 1.5-6 years). All patients engrafted; however, all patients died from 37 days to 1 year after HSCT. Causes of death included infections (n=2), multi-organ failure (n=1) and solid-organ graft rejection (n=1). Though three patients survived beyond day+100, multiple complications were observed including EBV re-activation followed by EBV-positive PTLD (n=1) and five episodes of severe infections. The patients transplanted for lymphoma did not have evidence of recurrence at last follow-up. Although feasibilty has been shown with this cohort, we conclude that allogeneic HSCT in immunosuppressed patients following solid-organ transplantation remains a very high risk procedure that results in severe morbidity and mortality in children.
authors.affiliation: Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada. tal.schechter-finkelstein@sickkids.ca
authors.forename: T
authors.initials: T
authors.lastname: Schechter
authors.forename: A
authors.initials: A
authors.lastname: Gassas
authors.forename: S
authors.initials: S
authors.lastname: Weitzman
authors.forename: D
authors.initials: D
authors.lastname: Grant
authors.forename: S
authors.initials: S
authors.lastname: Pollock-BarZiv
authors.forename: A
authors.initials: A
authors.lastname: Dipchand
authors.forename: S
authors.initials: S
authors.lastname: Alexander
authors.forename: M
authors.initials: M
authors.lastname: Ali
authors.forename: Y
authors.initials: Y
authors.lastname: Avitzur
authors.forename: J
authors.initials: J
authors.lastname: Doyle
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D016377:Organ Transplantation / Q000379:methods*; D016019:Survival Analysis; D014184:Transplantation, Homologous