Risk Factors for Solid Organ Graft Failure and Death in Solid Organ Transplant Recipients Undergoing Hematopoietic Cell Transplantation: A Retrospective Center for International Blood and Marrow Transplant Research (CIBMTR) and Organ Procurement and Transplantation Network (OPTN) Study.
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Gupta Meera, Schoettler Michelle L, Orozco Gabriel, Brazauskas Ruta, Bo-Subait Stephanie, Battiwalla Minoo, Buchbinder David, Hamilton Betty K, Savani Bipin N, Schoemans Hélène, Sorror Mohamed L, Ahmed Sairah, Badawy Sherif M, Bhushan Vikas, Birdsey Kelly, Couriel Daniel, Doherty Erin E, Donato Michelle, Farag Sherif S, Gutman Jonathan, Horwitz Mitchell, El Jurdi Najla, Maakaron Joseph E, Maziarz Richard T, Pineiro Luis, Schiller Gary, Weisdorf Daniel J, William Basem M, Shaw Bronwen E, Phelan Rachel, Porter David L, Levine Matthew, Abt Peter L
Аннотация
METHODS: This retrospective Center for International Blood and Marrow Transplant Research study included recipients of SOT followed by HCT between 1989 and 2017. HCT data were merged with organ transplant data from the Organ Procurement and Transplantation Network.
RESULTS: Eighty-three patients with an SOT underwent an HCT. Organs transplanted included heart/lung (thoracic, n = 15), kidney (n = 42), and liver (n = 26); 24 patients (29%) received a living donor graft and 59 (71%) a deceased graft. Forty-one patients (49.4%) received an allogeneic HCT and 42 (50.6%) an autologous HCT. Three-year overall survival (OS) from HCT in the entire cohort was 38.6%. There were no significant differences in OS by SOT type, although 3-y OS appeared lowest in the kidney SOT group at 29.9%, compared with liver SOT at 40.6% and thoracic SOT at 58.2%. The incidence of SOT graft failure 3 y post-HCT was 59.1%. There were no significant differences in SOT graft failure by organ type: 3-y failure probability 67.2% for kidney, 56.5% for liver, and 46.2% for thoracic. Shared risk factors for death and graft failure included HCT indication (leukemia, lymphoma, and nonmalignant diseases), HCT type (allogeneic), and SOT type (kidney).
CONCLUSIONS: Although some SOT recipients may benefit from HCT, the incidence of SOT graft failure was high and OS was poor, particularly after allogeneic HCT.