Hematopoietic Cell Transplantation after Solid Organ Transplantation

• Outcomes of both autologous and allogeneic HCT performed after solid organ transplantation were reviewed.
• Rejection of either the solid organ or the hematopoietic cell graft occurred rarely and was usually reversed with an increase in immunosuppression therapy.
• Graft-versus-host disease was not a limiting factor.
• The major cause of death for both autologous and allogeneic HCT recipients was persistence or relapse of the hematologic disease.
• Multiple solid organ or hematopoietic transplants have been successful in carefully selected patients.

Solid organ transplantation (SOT) followed by hematopoietic cell transplantation (HCT) has been used to treat a single disease with multiorgan involvement or 2 separate diseases, the first requiring SOT and the second often a possible complication of SOT. Results of such serial transplants have been reported sporadically in the literature, usually as single case studies. Thirteen autologous and 27 allogeneic HCTs after SOT published previously are summarized. A more detailed review is provided for an additional 16 patients transplanted at a single institution, 8 of whom had autologous and 8 of whom had allogeneic HCT after SOT. Five of 8 autologous transplant recipients are alive a median of 4.6 years after HCT. Four of 8 allogeneic HCT recipients are alive a median of 8.7 years after HCT. In carefully selected patients, HCT after SOT is feasible and associated with a low incidence of either solid organ or hematopoietic cell rejection.