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Sequential transplantation and implications for clinical management: OLT followed by HCT and consequent RT in a pediatric patient. Pediatr Transplant 2019 05;23(3):e13370



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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


Lynnette J. Anderson NP Manager NP/PA in the Pediatrics department at Medical College of Wisconsin
David A. Margolis MD Interim Chair, Professor in the Pediatrics department at Medical College of Wisconsin
Rachel A. Phelan MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin

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

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