Lung transplant recipients on long‐term extracorporeal photopheresis

Abstract

Extracorporeal photophoresis (ECP) is an increasingly used therapy to address chronic lung allograft dysfunction (CLAD) following lung transplantation. In 2008, we reported the first single-center experience showing that ECP not only reduces lung function decline in patients with bronchiolitis obliterans syndrome (BOS) but results in stabilization of patients with recurrent acute cellular rejection (ACR). In this study, the original cohort was followed up further 5 years. In addition, patients with CLAD were retrospectively classified according to recently published phenotypes. The current cohort included 21 of the original 24 patients, of which nine were initially treated for CLAD, 12 were initially treated for recurrent ACR. Our results show that survival of patients treated with ECP for CLAD was inferior to patients treated for recurrent ACR (66% vs. 82% survival rate). Long-term survivors in the CLAD subgroup were mostly classified as BOS 1 at time of ECP initiation. These long-term data show that patients started on ECP at early BOS stages have better long-term outcome. The subgroup of ECP patients with recurrent ACR has an overall superior survival. To assist prediction of therapy response, we agree with other authors that patients with CLAD should be aimed to be phenotyped and evaluated for an early treatment with ECP.

Extracorporeal photopheresis as second‐line treatment therapy in life‐threatening primary graft dysfunction following lung transplantation

“…For obvious reasons, no mechanistic studies were performed in our case; therefore, the effects of ECP remain speculative. ECP has been used in CLAD/BOS as “second‐line” treatment option with favorable outcomes for more than 20 years as well as other indications like histologically proven recurrent acute cellular rejection . After initiation of ECP, we observed a prompt and lasting improvement of allograft function in our patient.…”

Apheresis buffy coat collection without photoactivation has no effect on apoptosis, cell proliferation, and total viability of mononuclear cells collected using photopheresis systems

“…Extracorporeal photopheresis (ECP) has been used to treat a number of immunologic diseases, although cutaneous T‐cell lymphoma is currently the only Food and Drug Administration–approved indication . An ECP treatment is composed of the ex vivo exposure of autologous white blood cells (WBCs) to a liquid formulation of 8‐methoxypsoralen (THERAKOS UVADEX, Therakos, Inc.) and ultraviolet A (UVA) light, followed by the subsequent reinfusion of the cells to the subject …”

Acute Cellular Rejection: Is It Still Relevant?

“…Second-line treatments that have been used include antilymphocyte antibodies, 155,[159][160][161] alemtuzumab, 155,160 aerosolized cyclosporine, 162 methotrexate, 163 total lymphoid irradiation, 164 and extracorporeal photopheresis. 165,166 Evidence is limited for these treatments in refractory ACR and comparative data are lacking.…”