Combined Haploidentical Hematopoetic Stem Cell Transplantation and Liver Transplantation in a Pediatric Patient

Vedat Uygun; İbrahim Aliosmanoğlu; Hayriye Daloğlu; Seda Öztürkmen; Koray Yalçın; Gülsün Karasu; Akif Yeşilipek

doi:10.18502/ijhoscr.v17i4.13921

Vedat Uygun İstinye University, Faculty of Medicine, MedicalPark Antalya Hospital, Department of Pediatric Bone Marrow Transplantation Unit, Antalya, Turkey
İbrahim Aliosmanoğlu İstinye University, Faculty of Medicine, MedicalPark Antalya Hospital, Department of General Surgery, Antalya, Turkey
Hayriye Daloğlu Antalya Bilim University, Faculty of Health Sciences, MedicalPark Antalya Hospital, Department of Pediatric Bone Marrow Transplantation Unit, Antalya, Turkey
Seda Öztürkmen MedicalPark Antalya Hospital, Department of Pediatric Bone Marrow Transplantation Unit, Antalya, Turkey
Koray Yalçın Bahçeşehir University, Faculty of Medicine, MedicalPark Göztepe Hospital, Department of Pediatric Bone Marrow Transplantation Unit, İstanbul, Turkey
Gülsün Karasu MedicalPark Göztepe Hospital, Department of Pediatric Bone Marrow Transplantation Unit, İstanbul, Turkey
Akif Yeşilipek MedicalPark Antalya Hospital, Department of Pediatric Bone Marrow Transplantation Unit, Antalya, Turkey

DOI: https://doi.org/10.18502/ijhoscr.v17i4.13921

Keywords: Post-transplant cyclophosphamide; Liver transplantation; Hematopoetic stem cell transplantation

Abstract

Solid organ transplantation from the same donor is an established procedure for end-stage organ failure that developed after a previous hematopoietic stem cell transplantation (HSCT); however, it is rarely done in patients transplanted with unmanipulated haplo-HSCT. There are no pediatric reports regarding the long-term performance of organ transplantation after haplo-HSCT with post-transplant cyclophosphamide (PTCY).

A juvenile myelomonocytic leukemia patient, who underwent unmanipulated haplo-HSCT with PTCY from her mother at the age of 3 years, developed chronic liver graft versus host disease (GvHD) which was refractory to specific GvHD treatment. Liver transplantation (LT) from her mother (the donor of her haplo-HSCT) was decided as the next line of treatment.

LT was performed on day 540 post-HSCT, and the donor's left lateral segment was appropriately removed and attached to the recipient. The symptoms of GvHD completely regressed in a month. The patient died on day 121 after LT, because of a possible hepato-pulmonary syndrome.

Organ failure can develop after allo-HSCT secondary to GvHD and therefore performing HSCT from a haplo-donor may be superior to a matched unrelated donor in terms of subsequent organ transplantation for organ failure.