Lung transplantation after allogeneic marrow transplantation in pediatric patients - The memorial Sloan-Kettering experience

Background. Chronic lung disease and pulmonary failure are complications that can occur after bone marrow transplantation (BMT) and are associated with severe morbidity and mortality. Methods. We report on four patients who developed chronic, progressive, and irreversible lung disease I to 3 years after allogeneic BMT in childhood. These patients had chronic graft-versus-host disease (n=3) or radiation-related pulmonary fibrosis (n=1). Three patients underwent double lung transplants and one patient underwent a single lung transplant 2 to 14 years after BMT. Results. All four patients tolerated the lung transplantation procedure well and showed significant clinical improvement with normalization of pulmonary function tests by 1 year posttransplant. One patient died from infectious complications 3 years after lung transplantation, and one patient died after chronic rejection of the transplanted lungs 6 years posttransplant. Two patients remain alive without significant respiratory impairment 2 and 7 years after lung transplantation. Conclusion. We conclude that lung transplantation offers a viable therapeutic option for patients who develop respiratory failure secondary to BMT.