Lung Transplantation for Pulmonary Graft Versus Host Disease: Experience from a Referral Organ Transplantation Center

Abstract Introduction: Severe pulmonary GvHD after allo-HCT is a significant cause of morbidity and mortality with limited therapeutic options. Selected patients can be lung transplanted, however there are no consensus guidelines on whom to select nor on when to refer. Method: Retrospective review of patients who underwent LT for lung GvHD after allo-HCT. Results: Ten patients were identified between January 2002 and December 2020. The median age at LT was 31 years. Seven patients developed aGvHD after allo-HCT and all patients developed cGvHD. The median immunosuppressive lines used before lung transplant was four. The median time between allo-HCT and bronchiolitis obliterans syndrome was 20.5 months. The median time from allo-HCT to LT was 71 months. The median time from first lung transplant evaluation to actual LT was 61 months. The median time from listing for LT to actual LT was 4.8 months. The median FEV1 upon referral to LT clinic was 31% and the median FEV1 upon LT was 25%. All patients received cadaveric bilateral lung transplants. After a median follow up of 4.5 years post-LT, the estimated 5-years OS after LT was 85.7%. The cumulative incidence of CLAD was 50% with a median time from LT to CLAD of 47 months. The CLAD-free survival at 5 years was 50%. Two patients died after developing CLAD complications. No hematologic relapse nor secondary malignancies reported. Conclusion: LT is an effective intervention for selected lung GvHD patients. Multidisciplinary management and consensus guidelines are needed to better serve these patients.