Lung transplantation following hematopoietic stem cell transplantation: report of two cases and systematic review of literature

Clin Transplant. 2014 Jul;28(7):776-82. doi: 10.1111/ctr.12378. Epub 2014 May 21.


Background: Non-infectious pulmonary complications following hematopoietic stem cell transplantation (HSCT) are major cause of morbidity and mortality with limited treatment options. Lung transplantation (LT) has been rarely reported as a treatment option for selected HSCT recipients with these problems.

Objective: Describe the outcome of HSCT recipients who underwent LT.

Methods: Two cases of LT following HSCT from our institution are presented. Cases reported in literature were identified using English language PubMed/MEDLINE with keywords hematopoietic stem cell transplantation, bone marrow transplantation, or bronchiolitis obliterans cross-referenced with lung transplantation. We extracted data on baseline characteristics and survival data following LT.

Results: Total of 84 patients are analyzed. Age at time of LT was median of 22 yr (range 1-66). Seventy-nine patients were recipients of allogeneic HSCT. The indications for LT were bronchiolitis obliterans syndrome (BOS; 63 patients), pulmonary fibrosis (13 patients), BOS/pulmonary fibrosis (five patients), and graft-versus-host-disease (GVHD) of lung (three patients). The median time between HSCT and LT was 52.3 months (range 6-240). The median follow-up after LT was 36 months (range 0-168). During this time, BOS was documented in 25 patients. Relapse of hematological malignancy was reported in two patients, and new malignancy developed in four patients. At the end of follow-up, 60 patients were alive and 24 patients died. The probability of survival following LT at 24 and 36 months was 0.88 (95% CI 0.78-0.93) and 0.79 (95% CI 0.67-0.87), respectively.

Conclusion: LT is a potential therapeutic option in selected patients with severe chronic pulmonary disease following HSCT. Further studies are needed to determine the appropriate timing and the outcome of this approach.

Keywords: bronchiolitis obliterans; hematopoietic stem cell transplantation; lung transplantation; outcome; survival.

Publication types

  • Case Reports
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Female
  • Graft vs Host Disease / etiology
  • Graft vs Host Disease / surgery*
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / complications*
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / therapy
  • Lung Diseases / etiology
  • Lung Diseases / surgery*
  • Lung Transplantation*
  • Male
  • Middle Aged
  • Prognosis