Solid organ transplantation in primary mitochondrial disease: Proceed with caution

Area of Science:

• Transplantation Medicine
• Genetics
• Rare Diseases

Background:

• Solid organ transplantation is infrequently performed in patients with primary mitochondrial disease.
• Existing data on outcomes are limited to case reports and small series.
• The impact of specific genetic mitochondrial diseases on transplant outcomes is not well understood.

Purpose of the Study:

• To evaluate post-transplant outcomes in adult and pediatric patients with primary mitochondrial disease.
• To determine if the underlying genetic cause of mitochondrial disease affects transplant morbidity and mortality.
• To assess the safety and tolerability of solid organ transplantation in this patient population.

Main Methods:

• Retrospective data collection from 35 patients across 17 transplant centers.
• Analysis of outcomes following liver, kidney, or heart transplantation.
• Comparison of outcomes between patients with and without POLG-related mitochondrial disease.

Main Results:

• Excluding POLG-related disease, post-transplant survival was comparable to non-mitochondrial disease patients.
• Most patients (majority) did not experience worsening of their mitochondrial disease within 90 days post-transplant.
• Post-transplant complications, including organ rejection, were infrequent and manageable.

Conclusions:

• Patients with mitochondrial disease generally tolerate solid organ transplantation well.
• Exclusion from transplantation solely based on mitochondrial disease diagnosis may not be warranted.
• POLG-related mitochondrial disease requires additional caution; transplant teams should consider mitochondrial disease in unexplained organ failure.