Reconsidering Indication of Lung Transplantation for Late-Onset Noninfectious Pulmonary Complications after Hematopoietic Stem Cell Transplantation

Abstract

Purpose Late-onset noninfectious pulmonary complications (LONIPCs) after hematopoietic stem cell transplantation (HSCT) may occur within 2 years after HSCT. Its prognosis is still poor with a survival rate of less than 20 % at 5 years after its diagnosis, and early lung transplantation (LT) may be required in some cases. However, according to the current international guideline, the time interval between HSCT and LT must be more than 5 years for patients with a history of hematologic malignancy. It should be also noted that blood type may be changed at the time of HSCT, however, ABO-incompatible lung transplantation is contraindicated in general. Therefore, we devised the following two policies.First, when the relapse risk of the original hematologic malignancy is judged to be less than 30 % by expert hematologists, patients are accepted as LT candidates.Second, when a recipient has no anti-A and / or B antibodies after HSCT, donors with incompatible ABO blood type have been accepted in living-donor lobar lung transplantation (LDLLT). The aim of this study was to assess LT outcomes in such patients. Methods Retrospective chart review was performed to identify patients who underwent LT for LONIPCs after HSCT at our institution between 2008 and 2017. Results Forty patients (32 LDLLTs) were identified. The median time interval between HSCT and LT was 64.5 months (range, 14-188 months). Thirty-one patients underwent HSCT for hematologic malignancy, and no patient developed relapse of the original hematologic malignancy after LT. The 5-year survival rate was 78.4 %. There was no significant difference in survival between patients with the time interval of more than 5 years (n=27) and less than 5 years (n=13). There were 4 cases of ABO incompatible LDLLTs. None of them developed complications related to ABO incompatibility. Conclusion Contrary to the current international guideline, our results suggest that carefully selected patients with LONIPCs may be accepted as lung transplant candidates even when the time interval between HSCT and LT is less than 5 years. ABO incompatible LDLLTs may be indicated when the recipient has no antibody to the respective living-donors after HSCT.