Lung transplantation for pulmonary chronic graft-versus-host disease: a missed opportunity?

Andrea Zajacova; Hélène Schoemans; Mark Greer; Hildegard Greinix; Peter Jaksch; Osnat Shtraichman; Rayid Abdulqawi; Are M Holm; Robin Vos; Saskia Bos

doi:10.1016/j.jhlto.2025.100209

Lung transplantation for pulmonary chronic graft-versus-host disease: a missed opportunity?

JHLT Open. 2025 Jan 28:7:100209. doi: 10.1016/j.jhlto.2025.100209. eCollection 2025 Feb.

Authors

Andrea Zajacova^{1

2}, Hélène Schoemans^{3

4}, Mark Greer⁵, Hildegard Greinix⁶, Peter Jaksch⁷, Osnat Shtraichman⁸, Rayid Abdulqawi⁹, Are M Holm¹⁰, Robin Vos^{1

2}, Saskia Bos^{1

2}

Affiliations

¹ Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
² Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Dept. of CHROMETA, KU Leuven, Leuven, Belgium.
³ Department of Haematology, Bone marrow Transplant Unit, University Hospitals Leuven, Leuven, Belgium.
⁴ KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium.
⁵ Department of Respiratory Medicine & Infectious Diseases, Hannover Medical School, Hannover, Germany.
⁶ Division of Haematology Medical University Graz, Graz, Austria.
⁷ Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
⁸ Pulmonary Institute, Rabin Medical Center, Affiliated with Sackler School of Medicine Tel Aviv University, Petach Tikva, Israel.
⁹ Lung Health Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
¹⁰ Dept of Respiratory Medicine, Oslo University Hospital, Oslo, Norway.

Abstract

Chronic graft-versus-host disease is a common complication after allogeneic hematopoietic stem cell transplantation, with pulmonary chronic graft-versus-host disease (PcGvHD) particularly associated with a dismal prognosis. Lung transplantation (LuTx) is a final therapeutic option for well-selected patients affected by this condition. Nevertheless, only a small group of PcGvHD patients are referred for LuTx. This review addresses common concerns regarding referral and listing of PcGvHD patients for LuTx (such as risk of relapse of hematological malignancy, infectious complications and rejection) and survival outcomes of this specific cohort of patients. Importantly, LuTx for PcGvHD has comparable outcomes to other indications. The establishment of specific LuTx indication criteria for PcGvHD patients may improve referral rates and timing of both referral and listing of suitable candidates.

Keywords: Bronchiolitis obliterans; GvHD; Lung transplantation; Pulmonary graft-versus-host disease; Restrictive allograft syndrome; Syndrome.

Publication types

Review