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Heart Failure Reviews

, Volume 23, Issue 2, pp 173–180 | Cite as

Transplantation in patients with iron overload: is there a place for magnetic resonance imaging?

Transplantation in iron overload
  • Sophie Mavrogeni
  • Genovefa Kolovou
  • Boris Bigalke
  • Angelos Rigopoulos
  • Michel Noutsias
  • Stamatis Adamopoulos
Article

Abstract

In iron overload diseases (thalassemia, sickle cell, and myelodysplastic syndrome), iron is deposited in all internal organs, leading to functional abnormalities. Hematopoietic stem cell transplantation (HSCT) is the only treatment offering a potential cure in these diseases. Our aim was to describe the experience in the field and the role of magnetic resonance imaging in the evaluation of iron overload before and after HSCT. Magnetic resonance imaging (MRI), using T2*, is the most commonly used tool to diagnose myocardial-liver iron overload and guide tailored treatment. Currently, HSCT offers complete cure in thalassemia major, after overcoming the immunologic barrier, and should be considered for all patients who have a suitable donor. The overall thalassemia-free survival of low-risk, HLA-matched sibling stem cell transplantation patients is 85–90%, with a 95% overall survival. The problems of rejection and engraftment are improving with the use of adequate immunosuppression. However, a detailed iron assessment of both heart and liver is necessary for pre- and post-transplant evaluation. In iron overload diseases, heart and liver iron evaluation is indispensable not only for the patients’ survival, but also for evaluation before and after HSCT.

Keywords

Thalassemia major Sickle cell disease Myelodysplastic syndrome Magnetic resonance imaging Iron overload Transplantation 

Notes

Authors’ contributions

All authors have equally contributed to the creation of this manuscript

Compliance with ethical standards

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Availability of data and material

Not applicable

Funding Information

MN has received grants from the Deutsche Forschungsgemeinschaft through the Sonderforschungsbereich Transregio 19 “Inflammatory Cardiomyopathy” (SFB TR19; TP B2), and by the University Hospital Giessen and Marburg Foundation Grant (UKGM 10/2009 “T cell functionality in DCMi”). MN has been consultant to the IKDT (Institute for Cardiac Diagnosis and Therapy GmbH, Berlin) in 2004–2008, and has received honoraria for presentations and/or participated in advisory boards from AstraZeneca, Bayer, Fresenius, Miltenyi Biotec, Novartis, Pfizer, and Zoll.

Conflict of interest

The authors declare that they have no conflict of interest.

Abbreviations

TMthalassemia

SCAsickle cell anemia

MDSmyelodysplastic syndrome

MRImagnetic resonance imaging

OHT/OLTorthotopic heart and liver transplantation

HSCThematopoietic stem cell transplantation

MELDmodel for end-stage liver disease

IOCiron overload cardiomyopathy

GVHDgraft-versus-host disease

HbShemoglobin S

CMRcardiovascular magnetic resonance

MUDmatched unrelated donor

mMUDmismatched unrelated donor

UCBumbilical cord blood

RHCresidual host hematopoietic cells

BMTbone marrow transplantation

TRMtransplant-related mortality

HLAhuman leukocyte antigen

CYcyclophosphamide

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sophie Mavrogeni
    • 1
    • 2
  • Genovefa Kolovou
    • 1
  • Boris Bigalke
    • 3
  • Angelos Rigopoulos
    • 4
  • Michel Noutsias
    • 5
  • Stamatis Adamopoulos
    • 1
  1. 1.Onassis Cardiac Surgery CenterAthensGreece
  2. 2.AthensGreece
  3. 3.Department of CardiologyCharité - Universitätsmedizin BerlinBerlinGermany
  4. 4.Department of CardiologyLeopoldina HospitalSchweinfurtGermany
  5. 5.Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical CareUniversity Hospital Jena, Friedrich-Schiller-University JenaJenaGermany

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