Faculty Collaboration Database

Sequential transplantation and implications for clinical management: OLT followed by HCT and consequent RT in a pediatric patient. Pediatr Transplant 2019 May;23(3):e13370

Date

02/20/2019

Pubmed ID

30779289

DOI

10.1111/petr.13370

Scopus ID

2-s2.0-85061909142 (requires institutional sign-in at Scopus site)

Abstract

We report a case of a pediatric patient who required three separate transplants: OLT at the age 5, HCT at age 13 (8 years post-OLT), and cadaveric RT at age 15 (10 years post-OLT). The child initially presented with fulminant liver failure without known cause, ultimately undergoing OLT from his mother. He then developed SAA, for which he required HCT. Unfortunately, he developed ESRD secondary to prolonged CNI exposure, for which he underwent cadaveric RT. These processes then resulted in 7 years largely free from complications, during which a multi-disciplinary team monitored the patient for complications. Regrettably, at the age of 21 he developed poorly differentiated mucinous adenocarcinoma of the colon which ultimately led to his demise. While there are case reports of patients requiring two sequential transplants, there is a paucity of reports of successfully completing three separate organ transplants in the same patient. Our case demonstrates progression of a pediatric patient through OLT, HCT, and RT with discussion of notable clinical implications. Secondarily, this case highlights the importance of coordination of care amongst various subspecialties to facilitate tandem transplantations and manage the complications of these processes. As pediatric patients have improved survival rates and may require multiple transplants, it remains important to highlight the feasibility as well as the complications of the tandem transplant process.

Author List

Hoogenboom L, Margolis D, Anderson L, Phelan R

Authors

Lynnette J. Anderson NP APP Mgr Hybrid in the Pediatrics department at Medical College of Wisconsin
David A. Margolis MD Chair, Professor in the Pediatrics department at Medical College of Wisconsin
Rachel A. Phelan MD, MPH Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Calcineurin Inhibitors
Colonic Neoplasms
Fatal Outcome
Graft Survival
Hematopoietic Stem Cell Transplantation
Humans
Kidney Failure, Chronic
Kidney Transplantation
Liver Failure, Acute
Liver Transplantation
Male
Tissue Donors
Treatment Outcome
Young Adult