Immunogenic and immunotolerogenic effects of extracorporeal photopheresis in high immunological risk kidney recipients. A single center case series

Abstract

The immunomodulatory effects of extracorporeal photopheresis (ECP) have been used for the treatment of T‐cell mediated disorders, such as rejection in organ transplantation. Currently, it is an established therapy for heart and lung rejection, but not for kidney transplantation (KT), where experience is limited. In addition, some data suggest that ECP could generate an immune response against infections, thus being an alternative for the treatment of rejection in case of active or high‐risk of infection. In the present study, we analyze four cases of use of ECP as concomitant therapy in patients with KT and high risk of opportunistic infections due to the high burden of immunosuppression throughout their renal diseases. Two patients had concomitant viral infection (cytomegalovirus and BK virus, respectively) and three patients were on treatment for graft rejection. In the two patients with active viral infection, the infection was successfully controlled during ECP treatment. In all cases, ECP has been shown to be a safe procedure, without complications.

The value of extracorporeal photopheresis as an immunosuppression-modifying approach in solid organ transplantation: a potential solution to an unmet medical need

“…In a case series of four kidney transplant patients, all of whom were considered as high immunological risk recipients due to previous transplantation or calculated PRA I +II levels of >50%, three patients presented stabilization of renal function during ECP treatment ( 64 ). In the fourth patient, no improvement was observed following ECP treatment and the patient experienced a progression to kidney graft failure.…”

Novel insights in the clinical management of hyperimmune patients before and after transplantation

“…Its use is still debated in renal transplantation due to the lack of studies on the safety and effectiveness of the technique ( Kusztal et al, 2011 ). Recent evidence has indicated photopheresis as a suitable treatment in reduction of antibody titer and renal failure progression in patients with chronic renal AMR, modulating the immune cellular and humoral responses, without complications ( Gregorini et al, 2021 ; Xipell et al, 2022 ).…”

“…Moreover, this removal is only short-lived with antibodies rebounding to pretreatment levels following re-equilibration between intravascular and interstitial compartments ( Xipell et al, 2022 ). Among the desensitization treatments, it is a poor treatment choice as sole therapy because the plasmapheresis does not affect ongoing antibody production by plasma cells and cause a lot of side effects as coagulopathy, hypocalcemia, thrombocytopenia, hypotension and catheter-related infection and sepsis ( Rodrigo et al, 2020 ).…”