Combined Haploidentical Hematopoetic Stem Cell Transplantation and Liver Transplantation in a Pediatric Patient
Abstract
Solid organ transplantation from the same donor is an established procedure for end-stage organ failure that developed after a previous hematopoietic stem cell transplantation (HSCT); however, it is rarely done in patients transplanted with unmanipulated haplo-HSCT. There are no pediatric reports regarding the long-term performance of organ transplantation after haplo-HSCT with post-transplant cyclophosphamide (PTCY).
A juvenile myelomonocytic leukemia patient, who underwent unmanipulated haplo-HSCT with PTCY from her mother at the age of 3 years, developed chronic liver graft versus host disease (GvHD) which was refractory to specific GvHD treatment. Liver transplantation (LT) from her mother (the donor of her haplo-HSCT) was decided as the next line of treatment.
LT was performed on day 540 post-HSCT, and the donor's left lateral segment was appropriately removed and attached to the recipient. The symptoms of GvHD completely regressed in a month. The patient died on day 121 after LT, because of a possible hepato-pulmonary syndrome.
Organ failure can develop after allo-HSCT secondary to GvHD and therefore performing HSCT from a haplo-donor may be superior to a matched unrelated donor in terms of subsequent organ transplantation for organ failure.
2. Mahr B, Granofszky N, Muckenhuber M, et al. Transplantation Tolerance through Hematopoietic Chimerism: Progress and Challenges for Clinical Translation. Front Immunol. 2017;8:1762.
3. Rao AS, Fontes P, Zeevi A, et al. Combined bone marrow and whole organ transplantation from the same donor. Transplant Proc. 1994;26(6):3377-8.
4. Kawai T, Cosimi AB, Spitzer TR, et al. HLA-mismatched renal transplantation without maintenance immunosuppression. N Engl J Med. 2008;358(4):353-61
5. Doney KC, Mielcarek M, Stewart FM, et al. Hematopoietic Cell Transplantation after Solid Organ Transplantation. Biol Blood Marrow Transplant. 2015;21(12):2123-2128.
6. Chen YB, Elias N, Heher E, et al. Haploidentical hematopoietic cell and kidney transplantation for hematological malignancies and end-stage renal failure. Blood. 2019;134(2):211-215.
7. Fangmann J, Kathrin Al-Ali H, Sack U, et al. Kidney transplant from the same donor without maintenance immunosuppression after previous hematopoietic stem cell transplant. Am J Transplant. 2011;11(1):156-62.
8. Brockmann JG, Broering DC, Raza SM, et al. Solid organ transplantation following allogeneic haematopoietic cell transplantation: experience from a referral organ transplantation center and systematic review of literature. Bone Marrow Transplant. 2019;54(2):190-203.
9. Doucette K, Shah NJ, Donato ML, et al. Immune tolerance with combined allogeneic haplo-identical haematopoietic stem cell transplant and renal transplant. Br J Haematol. 2021;194(4):779-783.
10. Jacobsen N, Taaning E, Ladefoged J, et al. Tolerance to an HLA-B,DR disparate kidney allograft after bone-marrow transplantation from same donor. Lancet. 1994;343(8900):800.
11. Matsuzaki A, Suminoe A, Koga Y, et al. Lung transplantation after hematopoietic stem cell transplantation from the same living donor in a child with juvenile myelomonocytic leukemia and bronchiolitis obliterans. Pediatr Blood Cancer. 2008;51(4):567.
12. Shah N, Vesole AS, Donate ML, et al. Successful Renal Transplant Tolerance Following a Haplo-Identical Allogenic Hematopoietic Stem Cell Transplant - a Case Report and Review of Literature. Blood. 2016;128(22):5879.
13. Nayyar D, Man HS, Granton J, et al. Defining and characterizing severe hypoxemia after liver transplantation in hepatopulmonary syndrome. Liver Transpl. 2014;20(2):182-90.
14. Koenecke C, Hertenstein B, Schetelig J, et al. Solid organ transplantation after allogeneic hematopoietic stem cell transplantation: a retrospective, multicenter study of the EBMT. Am J Transplant. 2010;10(8):1897-906.
15. Ma L, Han X, Jiang S, et al. Haploidentical stem cell transplantation vs matched unrelated donor transplantation in adults with hematologic malignancies: a systematic review and meta-analysis. Hematology. 2020;25(1):356-365.
16. Saglio F, Berger M, Spadea M, et al. Haploidentical HSCT with post transplantation cyclophosphamide versus unrelated donor HSCT in pediatric patients affected by acute leukemia. Bone Marrow Transplant. 2021;56(3):586-595.
17. Patzer L, Ringelmann F, Kentouche K, et al. Renal function in long-term survivors of stem cell transplantation in childhood. A prospective trial. Bone Marrow Transplant. 2001;27(3):319-27.
18. Saddadi F, Hakemi M, Najafi I, et al. Chronic kidney disease after hematopoietic cell transplantation: frequency, risk factors, and outcomes. Transplant Proc. 2009;41(7):2895-7.
19. Dudek AZ, Mahaseth H, DeFor TE, et al. Bronchiolitis obliterans in chronic graft-versus-host disease: analysis of risk factors and treatment outcomes. Biol Blood Marrow Transplant. 2003;9(10):657-66.
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Issue | Vol 17, No 4 (2023) | |
Section | Case Report(s) | |
DOI | https://doi.org/10.18502/ijhoscr.v17i4.13921 | |
Keywords | ||
Post-transplant cyclophosphamide; Liver transplantation; Hematopoetic stem cell transplantation |
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