How Often Is Surgery Needed in Hematopoietic Stem Cell Transplantation?

Hematopoietic stem cell transplantation (HSCT) involves the intravenous infusion of stem cells to restore bone marrow function in patients with bone marrow disorders. This study aimed to evaluate the complications of HSCT, mainly gastrointestinal, hepatobiliary, urinary, and pulmonary complications, and their incidence, severity, impacts on survival, and the importance of the surgical role in managing these complications. We retrospectively studied 433 patients treated at the IOP-GRAACC/Unifesp for a period of 10 years, with an average age of 8.8 years. The most frequent primary diseases were leukemia (33.5%) and lymphoma (13.2%). Most patients had complications (96.3%), of which half had only one complication (51.3%). Approximately 298 patients had gastrointestinal complications, with mucositis being the most common one (95.3%). Approximately 6.7% of the patients had some hepatobiliary complications; sinusoidal obstruction syndrome (SOS) occurred in 72.4% of these. Only 9.2% of patients had hemorrhagic cystitis, and most cases were classified as acute, grade I, or mild. Pulmonary complications including viral pneumonia (35.9%), bacterial pneumonia (23.1%), and fungal pneumonia (15.4%) were also recorded. Only 2.1% of patients had aspergillosis. Approximately 37.6% of the patients died, 55.2% were alive, and 7.2% were alive with the disease. The most frequent cause of death among patients was disease progression (72.4%). Only two patients underwent surgery. We concluded that the incidence of HSCT complications was 96.3%; however, it was not possible to determine the risk factors for the need for surgical treatment in these patients, although surgical evaluation in the decision-making process remains essential.