Department of Haematology, St. Vincent's Hospital Sydney, Sydney, NSW, Australia.
Department of Lung Transplantation, The Alfred Hospital, Melbourne, VIC, Australia.
Transplantation. 2019 Dec;103(12):2602-2607. doi: 10.1097/TP.0000000000002693.
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.
We investigated the outcomes of LTx performed for this indication at 2 large Australian LTx centers.
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.
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.
严重的肺部慢性移植物抗宿主病（GVHD）是异基因造血干细胞移植的一种危及生命的并发症。很少有治疗方法能影响预后，5 年总生存率低至 13%。肺移植（LTx）已在全球少数患者中报告。
我们调查了澳大利亚 2 个大型 LTx 中心因该指征进行 LTx 的结果。
18 例患者（年龄 10-64 岁；中位数，29.6 岁）在 2002 年至 2017 年间因肺部慢性 GVHD 接受了双侧已故肺移植。LTx 在异基因干细胞移植后中位数为 8.6 年（范围，2-23 年），从移植单位审查到 LTx 的中位数间隔为 16 个月。有 2 例早期感染性死亡，另有 3 例死于肺部感染和肺移植物排斥。没有原发性疾病复发。中位随访 5 年后，LTx 后 5 年总生存率为 80%，与澳大利亚和新西兰登记处为所有适应证进行 LTx 的 64%数据相当。
从该适应证最大的 LTx 系列之一中得出结论，对于患有严重肺部 GVHD 的选定患者，这是一种可行的选择。结果似乎优于非 LTx 治疗方法，与一般 LTx 人群的生存率相似。制定关于转诊触发因素、患者资格、器官选择、移植物排斥预防和支持性护理的指南，将有助于造血和肺移植单位优化资源分配和患者结局。
