A shared-care model for autologous transplantation: Feasibility and optimization of tertiary center resources
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Updated: Nov 2, 2026
A Modified Heterotopic Swine Hind Limb Transplant Model for Translational Vascularized Composite Allotransplantation (VCA) Research
Published on: October 14, 2013
Ana Jiménez-Ubieto1, Adolfo Jesús Sáez Marín1, Paula Lázaro2
1Department of Hematology, Hospital Universitario 12 de Octubre, Madrid, Spain; Imas12 Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.
Background:
the increasing demand for autologous stem cell transplantation (ASCT), together with the expansion of cellular therapies, is placing growing pressure on tertiary transplant center capacity. Although outpatient ASCT has demonstrated safety and efficacy, its implementation is often limited by logistical, social, and geographic constraints.
Objectives:
to evaluate the feasibility, safety, and clinical outcomes of a shared-care model based on early transfer to referral centers on day +1 after ASCT, compared with standard inpatient management.
Study Design:
we conducted a retrospective observational study including 360 patients undergoing ASCT for plasma cell disorders, lymphoid malignancies, or acute leukemia between January 2018 and December 2024. Fifty-five patients (15.3%) were transferred to referral centers on day +1 after stem cell infusion, while 305 were managed entirely at the transplant center. Clinical outcomes, complications, non-relapse mortality, and resource utilization were compared between groups using standard univariate statistical analyses.
Results:
baseline characteristics were generally comparable, although transferred patients had a lower comorbidity burden. Early transfer was associated with a median of 14 tertiary-center bed-days saved per patient (539 total). No significant differences were observed in febrile neutropenia, severe mucositis, ICU admission, or day +100 non-relapse mortality (2.4% in both cohorts; p = 0.643). Neutrophil engraftment was slightly delayed in transferred patients. Two transferred patients required readmission. Patient satisfaction was high across all evaluated domains.
Conclusions:
early transfer after ASCT within a structured shared-care model appears feasible and safe in carefully selected, clinically fit patients, reducing tertiary-center resource utilization while maintaining comparable early clinical outcomes in this selected cohort. This approach represents a pragmatic alternative in healthcare settings where outpatient ASCT programs are not widely available.
