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Favorable Outcome of Lung Transplantation for Severe Pulmonary Graft Versus Host Disease

An Australian Multicenter Case Series

Kliman, David S. MBBS1; Kotecha, Sakhee R. MBBS2; Abelson, David C. MBBS3; Snell, Gregory I. MBBS, MD2,4; Glanville, Allan R. MBBS, MD3,5; Ma, David D.F. MBBS, MD1,5

doi: 10.1097/TP.0000000000002693
Original Clinical Science—General
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Background. Severe pulmonary chronic graft versus host disease (GVHD) is a life-threatening complication of allogeneic hematopoietic stem cell transplantation. Few treatments influence outcome, with 5-year overall survival as low as 13%. Lung transplantation (LTx) has been reported in small numbers of patients worldwide.

Methods. We investigated the outcomes of LTx performed for this indication at 2 large Australian LTx centers.

Results. Eighteen patients (aged 10–64 y; median, 29.6 y) received bilateral deceased lung transplants for pulmonary chronic GVHD between 2002 and 2017. LTx was performed at a median of 8.6 years after allogeneic stem cell transplantation (range, 2–23 y) with a median interval of 16 months from the time of transplant unit review to LTx. There were 2 early infective deaths and 3 further deaths from pulmonary infection and lung allograft rejection. There were no primary disease relapses. At a median follow-up of 5 years, the 5-year overall survival post-LTx is 80% and comparable to the Australia and New Zealand registry data of 64% for LTx performed for all indications.

Conclusions. From one of the largest series of deceased LTx for this indication, we conclude that it is a feasible option for selected patients with severe pulmonary GVHD. The outcomes appear superior to that of non–LTx-based therapies and similar to the survival of the general LTx population. Establishing guidance on referral triggers, patient eligibility, organ selection, prophylaxis of allograft rejection, and supportive care would assist hematopoietic and lung transplant units in optimizing resource allocation and patient outcomes.

1 Department of Haematology, St. Vincent’s Hospital Sydney, Sydney, NSW, Australia.

2 Department of Lung Transplantation, The Alfred Hospital, Melbourne, VIC, Australia.

3 Lung Transplant Unit, St. Vincent’s Hospital, Sydney, NSW, Australia.

4 Department of Medicine, Monash University, Melbourne, VIC, Australia.

5 Department of Medicine, University of New South Wales, Sydney, NSW, Australia.

Received 19 November 2018. Revision received 24 January 2019.

Accepted 10 February 2019.

The authors declare no funding or conflicts of interest.

D.S.K. participated in research design, collected data, participated in data analysis, and participated in manuscript writing. S.R.K. and D.C.A. collected data, participated in data analysis, and participated in manuscript writing. G.I.S. and A.R.G. participated in research design and manuscript writing. D.D.F.M. participated in research design, analysis of data, and manuscript writing.

Correspondence: David D.F. Ma, MBBS, MD, Department of Haematology and Bone Marrow Transplant, St. Vincent’s Hospital Sydney, 370 Victoria St, Darlinghurst, NSW 2010, Australia. (a.lafferty@amr.org.au).

Current address for Dr Kliman: Malignant Haematology and Stem Cell Transplantation Service, The Alfred Hospital, Melbourne, Victoria, Australia.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.