Organ-related and miscellaneous complications

Transplant-related complications (excluding infections and graft-versus-host disease) page 380 Failure of sustained engraftment after allotransplantation 380 Hepatic veno-occlusive disease 381 Hemorrhagic cystitis 384 Transplant-associated microangiopathy 385 Calcineurin inhibitor–associated hypertension 386 Cyclosporin-associated blindness 386 Growth and development 389 New malignancy after BMT 389 Organ-related complications 392 Cardiac complications 392 Dermatologic complications 392 Endocrine complications 393 Eye complications 394 Gastrointestinal complications 396 Gynecologic complications 399 Fertility and infertility after hematopoietic stem cell transplantation 400 Hematologic complications 404 Hepatic complications 405 Musculoskeletal complications 406 Neurologic complications 406 Perianal complications 411 Psychosocial complications 411 Pulmonary complications 412 Renal complications 413 Vascular complications 414 Metabolic complications 415 Hyperkalemia 415 Hypokalemia 417 Hypercalcemia due to malignancy 417 Hypocalcemia 418 Hypomagnesemia 419 Hyponatremia 419 Hyperuricemia 419 Malignancy-related complications 420 Spinal cord compression 420 Upper airways obstruction 421 Tumor lysis syndrome 421 Miscellaneous complications 422 Anaphylaxis 422 Acute gout 424 Further reading 427 Transplant-related complications (excluding infections and graft-versus-host disease) Failure of sustained engraftment after allotransplantation Failure of sustained engraftment can be due to graft rejection allogeneic resistance Features of graft rejection: Previously sensitized recipient (due to blood transfusion or pregnancy) Mediated by recipient CD8⁺ T cells responding to MHC or minor histocompatibility antigens present on the donor's cells; occasionally can be mediated by recipient CD4⁺ T cells responding to an MHC Class II difference in the donor Features of allogeneic resistance: Unprimed recipient Mediated by recipient NK cells responding to histocompatibility antigen disparity Less evidence for this mechanism in man compared to that in animal model systems.