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Pediatric Transplants

Hematopoietic stem-cell transplantation following solid-organ transplantation in children

Bone Marrow Transplantation volume 46, pages 1321–1325 (2011)Cite this article

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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.

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Authors and Affiliations

  1. Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada

    T Schechter-Finkelstein, A Gassas, S Weitzman, S Alexander, M Ali & J Doyle

  2. SickKids Transplant Centre, The Hospital for Sick Children, Toronto, Ontario, Canada

    D Grant, S Pollock-BarZiv, A Dipchand & Y Avitzur

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  1. T Schechter-Finkelstein
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  2. A Gassas
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  3. S Weitzman
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  4. D Grant
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  5. S Pollock-BarZiv
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  7. S Alexander
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  8. M Ali
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  10. J Doyle
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Correspondence to T Schechter-Finkelstein.

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Schechter-Finkelstein, T., Gassas, A., Weitzman, S. et al. Hematopoietic stem-cell transplantation following solid-organ transplantation in children. Bone Marrow Transplant 46, 1321–1325 (2011). https://doi.org/10.1038/bmt.2011.153

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