Original Clinical Science—General

Risk Factors for Solid Organ Graft Failure and Death in Hematopoietic Cell Transplant Recipients Undergoing Solid Organ Transplantation: A Retrospective Center for International Blood and Marrow Transplant Research and Organ Procurement and Transplantation Network Study

  • Gupta, Meera MD, MSCE1
  • Schoettler, Michelle L. MD, MS2
  • Brazauskas, Ruta PhD4
  • Bo-Subait, Stephanie MPH5
  • Orozco, Gabriel MD6
  • Battiwalla, Minoo MD, MS7
  • Buchbinder, David MD, MSHS8
  • Hamilton, Betty K. MD9
  • Savani, Bipin N. MD10
  • Schoemans, Hélène MD, PhD11
  • Sorror, Mohamed L. MD13
  • Ahmed, Sairah MD14
  • Badawy, Sherif M. MD, MS, MBA16
  • Bhushan, Vikas MD17
  • Birdsey, Kelly BA19
  • Couriel, Daniel MD, MS20
  • Doherty, Erin E. MD21
  • Donato, Michelle MD, MBA22
  • Farag, Sherif S. MD, PhD23
  • Gutman, Jonathan MD24
  • Horwitz, Mitchell MD25
  • El Jurdi, Najla MD26
  • Maakaron, Joseph E. MD26
  • Maziarz, Richard T. MD27
  • Pineiro, Luis MD28
  • Schiller, Gary MD29
  • Weisdorf, Daniel J. MD26
  • William, Basem M. MD30
  • Shaw, Bronwen E. MD, PhD4
  • Phelan, Rachel MD, MPH31
  • Porter, David L. MD32
  • Abt, Peter L. MD33
  • Levine, Matthew MD, PhD34

  • 1

    Division of Transplantation, Department of Surgery, University of Kentucky, College of Medicine, Lexington, KY.

  • 2

    Children’s Healthcare of Atlanta, Aflac Blood and Cancer Disorder Center, Emory University, Atlanta, GA.

  • 3

    Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI.

  • 4

    CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI.

  • 5

    CIBMTR (Center for International Blood and Marrow Transplant Research), NMDP, Minneapolis, MN.

  • 6

    Oregon Health and Science University, Portland, OR.

  • 7

    Sarah Cannon Transplant and Cell Therapy Network, Nashville, TN.

  • 8

    Division of Pediatric Hematology, Children’s Hospital of Orange County, Orange, CA.

  • 9

    Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH.

  • 10

    Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.

  • 11

    Department of Hematology, University Hospitals Leuven, Leuven, Belgium and Department of Public Health and Primary Care, ACCENT VV, KU Leuven – University of Leuven, Leuven, Belgium.

  • 12

    Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA.

  • 13

    Department of Medicine, University of Washington School of Medicine, Seattle, WA.

  • 14

    Department of Lymphoma/Myeloma and Stem Cell Transplantation, University of Texas, MD Anderson Cancer Center, Houston, TX.

  • 15

    Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.

  • 16

    Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL.

  • 17

    Medical City Dallas Hospital, Dallas, TX.

  • 18

    The Colorado Blood Cancer Institute, a part of Sarah Cannon Cancer Institute at Presbyterian/St Luke’s Medical Center, Denver, CO

  • 19

    HCA Healthcare, Nashville, TN.

  • 20

    Transplant and Cellular Therapy Program, Huntsman Cancer Center Institute, University of Utah, Salt Lake City, UT.

  • 21

    Baylor College of Medicine/Texas Children’s Hospital, Houston, TX.

  • 22

    Hackensack University Medical Center, Hackensack, NJ.

  • 23

    Stem Cell Transplant and Cellular Therapy Institute, Community Health Network MD Anderson Cancer Center, Indianapolis, IN.

  • 24

    Division of Hematology, University of Colorado, Aurora, CO.

  • 25

    Duke University Medical Center, Durham, NC.

  • 26

    Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN.

  • 27

    Knight Cancer Institute, Oregon Health and Science University, Portland, OR.

  • 28

    Baylor University Medical Center, Dallas, TX.

  • 29

    Hematological Malignancy/Stem Cell Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, CA.

  • 30

    Ohio Health Blood and Marrow Transplant and Cell Therapy Program, Columbus, OH.

  • 31

    Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.

  • 32

    Center for Cell Therapy and Transplant, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.

  • 33

    Division of Transplantation, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.

  • 34

    Perelman School of Medicine University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, PA.

Received 21 June 2024. Revision received 7 November 2024.

Accepted 25 November 2024.

CIBMTR is supported primarily by the Public Health Service U24CA076518 from the National Cancer Institute, the National Heart, Lung and Blood Institute, and the National Institute of Allergy and Infectious Diseases; 75R60222C00011 from the Health Resources and Services Administration; and N00014-23-1-2057 and N00014-24-1-2057 from the Office of Naval Research. Support is also provided by the Medical College of Wisconsin, National Marrow Donor Program, Gateway for Cancer Research, Pediatric Transplantation and Cellular Therapy Consortium and from the following commercial entities: AbbVie, Actinium Pharmaceuticals Inc, Adaptive Biotechnologies Corporation, ADC Therapeutics, Adienne SA, Alexion, AlloVir Inc, Amgen Inc, Astellas Pharma US, AstraZeneca, Atara Biotherapeutics, BeiGene, BioLineRX, Blue Spark Technologies, bluebird bio Inc, Blueprint Medicines, Bristol Myers Squibb Co, CareDx Inc, CSL Behring, CytoSen Therapeutics Inc, DKMS, Editas Medicine, Elevance Health, Eurofins Viracor, DBA Eurofins Transplant Diagnostics, Gamida-Cell Ltd, Gift of Life Biologics, Gift of Life Marrow Registry, GlaxoSmithKline, HistoGenetics, Incyte Corporation, Iovance, Janssen Research & Development, LLC, Janssen/Johnson & Johnson, Jasper Therapeutics, Jazz Pharmaceuticals Inc, Karius, Kashi Clinical Laboratories, Kiadis Pharma, Kite, a Gilead Company, Kyowa Kirin, Labcorp, Legend Biotech, Mallinckrodt Pharmaceuticals, Med Learning Group, Medac GmbH, Merck & Co, Mesoblast, Millennium, the Takeda Oncology Co, Miller Pharmacal Group Inc, Miltenyi Biomedicine, Miltenyi Biotec Inc, MorphoSys, MSA-EDITLife, Neovii Pharmaceuticals AG, Novartis Pharmaceuticals Corporation, Omeros Corporation, OptumHealth, Orca Biosystems Inc, OriGen BioMedical, Ossium Health Inc, Pfizer Inc, Pharmacyclics LLC, An AbbVie Company, PPD Development LP, REGiMMUNE, Registry Partners, Rigel Pharmaceuticals, Sanofi, Sarah Cannon, Seagen Inc, Sobi Inc, Stemcell Technologies, Stemline Technologies, STEMSOFT, Takeda Pharmaceuticals, Talaris Therapeutics, Vertex Pharmaceuticals; Vor Biopharma Inc, and Xenikos BV.

M.L. Schoettler reported consulting and honorarium from Omeros and Alexion. M.B. reported research support to their Institution from Novartis. B.K.H. reported (ad hoc) to be part of advisory boards for Nkarta, Sanofi, Incyte, Rigel, and Maat; provided consultancy for ACI Group; received speaker fees from Therakos/Mallinckrodt; data safety monitoring committee for Angiocrine; and adjudication committee with CSL Behring. H.S. reported having received personal fees from Incyte, Janssen, Novartis, and Sanofi; the Belgian Hematological Society paid to her institution; and served as a volunteer for the European Society for Blood and Marrow Transplantation. M.L. Sorror reported receiving honoraria from JAZZ Pharmaceuticals Canada and research funding per a contract with Massachusetts General Hospital. S.A. reported research support to institution for clinical trials from Seattle Genetics, Merck, Xencor, Chimagen, and Tessa Therapeutics; has membership on Tessa Therapeutic’s and Chimagen scientific advisory committee; serves on Data Safety Monitoring Board for Myeloid Therapeutics; and is a consultant for ADC therapeutics, KITE/Gilead. J.E.M. reports his institution receives research funding on his behalf from Gilead, Atara, CRISPR, Precision Biosciences, Scripps Research Institute, VOR Bio, and Affimed. R.T.M. reported serving as a consultant for Autolous, Kite/Gilead, and Novartis; received research support from Gamida, OrcaBio, and Novartis; participated in DSMB for Athersys, Novartis, Century Therapeutics, and VorPharma; and is a patent with Athersys. B.M.W. reported to be part of the advisory board for Genmab and BMS and provided consultency for Guidepoint Global. B.E.S. reported providing consultency for Orcabio and Mallinckrodt. R.P. reported compensation from bluebird bio: advisory board and Amgen: research funding (ended December 2021). D.L.P. reported stock and other ownership interests: Genentech and Roche (Spouse former employment); consulting or advisory role: Novartis, Kite/Gilead, Janssen, BMS, Angiocrine, Mirror Biologics, Capstan Therapeutics, Sana Biotechnology, Verismo Therapeutics; research funding: Novartis; BMS (consortium); patents, royalties, and other intellectual property: Novartis and Tmunity (D.L.P. is a patent inventor for the use of CAR T cells in CD19+ malignancies) and Elsevier (Deputy editor, Transplant and Cell Therapy (ASTCT journal).

P.L.A. and M.L. contributed equally to this work.

M.G., R.B., D.P., P.L.A., and M.L. participated in initial research design, acquisition of the data, data analysis, and writing the article. M.G., M.L. Schottler, S.B.-S., B.E.S., and R.P. were responsible for study design updates, analyzing data and interpreting results, and writing and editing the article. G.O., M.B., D.B., B.K.H., B.E.S., H.S., and M.L. Schottler assisted in study design updates, critically reviewed analysis and the article, and provided formative commentary. S.A., S.M.B., V.B., K.B., D.C., E.E.D., M.D., S.S.F., J.G., M.H., N.E.J., J.E.M., R.T.M., L.P., G.S., D.J.W., and B.M.W. critically reviewed the article and provided formative commentary.

CIBMTR supports the accessibility of research in accordance with the National Institutes of Health Data Sharing Policy and the National Cancer Institute Cancer Moonshot Public Access and Data Sharing Policy. The CIBMTR only releases de-identified data sets that comply with all relevant global regulations regarding privacy and confidentiality.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Correspondence: Rachel Phelan, MD, MPH, Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, 8701 Watertown Plank Rd, MFRC 3018, Milwaukee, WI 53226. ([email protected]).
Transplantation Publish Ahead of Print, June 23, 2025. | DOI: 10.1097/TP.0000000000005397

Background.

There is a growing population of hematopoietic cell transplantation (HCT) survivors who later require a solid organ transplant (SOT). However, there are limited data on survival, risk factors (RFs) for SOT graft loss, and death.

Methods.

This is a retrospective Center for International Blood and Marrow Transplant Research study that included recipients of HCT followed by SOT between 2001 and 2017. HCT data were merged with data from the Organ Procurement and Transplantation Network.

Results.

Eighty patients underwent autologous (45%) or allogeneic (55%) HCT followed by single SOT. Common indications for HCT included leukemia/myelodysplastic syndrome (45%) and plasma cell disorders (38.8%). The median time from HCT to SOT was 47.7 mo. There were 49 kidney, 26 thoracic, and 5 liver transplants. Overall survival from SOT was significantly different by organ (P = 0.01). Three-year overall survival by organ type was 85% among kidney, 70.7% among thoracic, and 30% among liver SOT recipients. Significant RFs for death included lymphoma versus plasma cell disorders and SOT type; thoracic and liver SOT carried a greater risk of death than kidney SOT. There was no significant difference in SOT failure incidence by SOT type; 3-y overall incidence was 27.8%. RFs for SOT graft loss included lymphoma, liver SOT, and positive recipient cytomegalovirus status at SOT.

Conclusions.

In this study, liver SOT recipients had inferior outcomes. However, renal and thoracic SOT recipients after HCT have acceptable outcomes compared with those of the general SOT population, and thus, SOT should be considered a viable treatment option in these patients.

Corresponding Article

Risk Factors for Solid Organ Graft Failure and Death in Solid Organ Transplant Recipients Undergoing Hematopoietic Cell Transplantation: A Retrospective Center for International Blood and Marrow Transplant Research (CIBMTR) and Organ Procurement and Transplantation Network (OPTN) Study

  • Gupta, Meera MD, MSCE1
  • Schoettler, Michelle L. MD, MS2
  • Orozco, Gabriel MD3
  • Brazauskas, Ruta PhD5
  • Bo-Subait, Stephanie MPH6
  • Battiwalla, Minoo MD, MS7
  • Buchbinder, David MD, MSHS8
  • Hamilton, Betty K. MD9
  • Savani, Bipin N. MD10
  • Schoemans, Hélène MD, PhD12
  • Sorror, Mohamed L. MD13
  • Ahmed, Sairah MD14
  • Badawy, Sherif M. MD, MS, MBA16
  • Bhushan, Vikas MD17
  • Birdsey, Kelly BA18
  • Couriel, Daniel MD, MS19
  • Doherty, Erin E. MD20
  • Donato, Michelle MD, MBA21
  • Farag, Sherif S. MD, PhD22
  • Gutman, Jonathan MD23
  • Horwitz, Mitchell MD24
  • El Jurdi, Najla MD25
  • Maakaron, Joseph E. MD25
  • Maziarz, Richard T. MD26
  • Pineiro, Luis MD27
  • Schiller, Gary MD28
  • Weisdorf, Daniel J. MD23
  • William, Basem M. MD29
  • Shaw, Bronwen E. MD, PhD5
  • Phelan, Rachel MD, MPH30
  • Porter, David L. MD31
  • Levine, Matthew MD, PhD32
  • Abt, Peter L. MD33
Transplantation Publish Ahead of Print, June 23, 2025. | DOI: 10.1097/TP.0000000000005377

Corresponding Article

Solid Organ Transplantation After Hematopoietic Cell Transplantation: Is the Evidence Solid Enough?

  • Puttarajappa, Chethan M. MD, MS1
Transplantation Publish Ahead of Print, June 23, 2025. | DOI: 10.1097/TP.0000000000005366
Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.
View full text|Download PDF