Solid organ transplantation in primary mitochondrial disease: Proceed with caution.
Solid organ transplants are rarely performed in both adult and pediatric patients with primary mitochondrial disease. Poor outcomes have been described in case reports and small case series. It is unclear whether the underlying genetic disease has a significant impact on post-transplant morbidity and mortality. Data were obtained for 35 patients from 17 Mitochondrial Disease Centers across North America, the United Kingdom and Australia. Patient outcomes were noted after liver, kidney or heart transplantation. Excluding patients with POLG-related disease, post-transplant survival approached or met outcomes seen in non-mitochondrial disease transplant patients. The majority of mitochondrial disease patients did not have worsening of their mitochondrial disease within 90-days post-transplant. Post-transplant complications, including organ rejection, were not a common occurrence and were generally treatable. Many patients did not have a mitochondrial disease considered or diagnosed prior to transplantation. In conclusion, patients with mitochondrial disease in this cohort generally tolerated solid-organ transplantation. Such patients may not need to be excluded from transplant solely for their mitochondrial diagnosis; additional caution may be needed for patients with POLG-related disease. Transplant teams should be aware of mitochondrial disease as an etiology for organ-failure and consider appropriate consultation in patients without a known cause of their symptoms.
Neurogenetics & Mitochondrial Disease, Center for Pediatric Neurology, Cleveland Clinic, Cleveland, OH, United States. Electronic address: parikhs@ccf.org.
Sumit
S
Parikh
Department of Medical Genetics, Massachusetts General Hospital, Boston, MA, United States.
Amel
A
Karaa
Center for Pediatric Neurology, Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.
Amy
A
Goldstein
Wellcome Trust Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK.
Yi S
YS
Ng
Wellcome Trust Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK.
Grainne
G
Gorman
Department of Medical Genetics, Rady Children's Hospital, San Diego, CA, United States.
Annette
A
Feigenbaum
Western Sydney Genetics Program, Children's Hospital at Westmead, Sydney and Disciplines of Paediatrics and Child Health and Genetic Medicine, University of Sydney, Sydney, Australia.
John
J
Christodoulou
Department of Pediatric Neurology, Rady Children's Hospital, San Diego, CA, United States.
Richard
R
Haas
Department of Pediatrics, Division of Neuromuscular and Neurometabolic Disease, McMaster University, Hamilton, ON, Canada.
Mark
M
Tarnopolsky
Department of Pediatric Neurology, Akron Children's Hospital, Akron, OH, United States.
Bruce K
BK
Cohen
Department of Medical Genetics, Medical College of Wisconsin, Milwaukee, WI, United States.
David
D
Dimmock
Department of Pediatric Neurology, Gillette Children's Specialty Healthcare, St. Paul, MN, United States.
Tim
T
Feyma
Department of Pediatrics, Division of Child & Adolescent Neurology, The University of Texas Medical School at Houston, Houston, TX, United States.
Mary K
MK
Koenig
Pediatric Metabolism, Evelina London Children's Healthcare, London, UK.
Helen
H
Mundy
Division of Medical Genetics, Department of Pediatrics, Ochsner Clinic Foundation, New Orleans, LA, United States.
Dmitriy
D
Niyazov
Department of Pediatric Neurology, Seattle Children's Hospital, Seattle, WA, United States.
Russell P
RP
Saneto
Department of Pediatrics, Division of Neurology, Lurie Children's Hospital, Chicago, IL, United States.
Mark S
MS
Wainwright
Department of Pediatric Neurology, Lucile Packard Children's Hospital, Palo Alto, CA, United States.
Courtney
C
Wusthoff
Wellcome Trust Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK.
Robert
R
McFarland
Department of Molecular and Human Genetics, Baylor College of Medicine, Baylor, TX, United States.
Fernando
F
Scaglia
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006331:Heart Diseases / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000628:therapy*; D016030:Kidney Transplantation; D008107:Liver Diseases / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D028361:Mitochondrial Diseases / Q000150:complications*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
Heart transplant; Kidney transplant; Liver transplant; Mitochondrial disease; Solid organ transplant