Update on extracorporeal photopheresis in heart and lung transplantation

Abstract

Transplant rejection of solid organs remains a threat to thousands of patients despite modern immunosuppressive regimens. The currently available drugs are associated with severe complications such as hypertension, diabetes mellitus, renal failure, risk of infections, and malignancies among many others and, often enough, still allow episodes of rejection. New and less-toxic immunologic measures are desperately needed to accomplish the desired tolerance to the transplant without the undesirable side effects. Extracorporeal photopheresis (ECP) has been shown to benefit especially patients with cardiac transplants, but also those who received lung allografts. ECP likely modulates the recipient's antigen-specific immune responses and inflammation in transplantation by in vivo generation of apoptotic leukocytes. This review will highlight the need for ECP, how it is thought to act, and the published evidence for its role in cardiac and pulmonary transplantation.

Extracorporeal Photopheresis Promotes IL-1β Production

“…The Journal of Immunology, 2015, 194: 2569-2577. E xtracorporeal photopheresis (ECP) is an immunomodulatory cellular therapy exhibiting clinical efficacy for attenuation of graft-versus-host disease (1-3) and solid organ transplant rejection (4) and for the treatment of cutaneous (5-7) and noncutaneous T cell lymphomas (8). ECP involves collection of leukocytes by apheresis that are exposed to 8-methoxypsoralen (8-MOP) and UVA light and retransfused into the patient (9).…”

Steady-State Cell Apoptosis and Immune Tolerance - Induction of Tolerance Using Apoptotic Cells in Type 1 Diabetes and Other Immune-Mediated Disorders

“…A retrospective analysis of 71 patients with severe chronic GVHD demonstrated that patients who had received ECP showed an overall response rate of 61%, and complete responses were observed in 20% of patients (98). ECP therapy has also been reported to provide positive clinical outcomes for the treatment of rejection episodes associated with cardiac and lung transplantation (99). In conclusion, published data demonstrate that patients with conditions characterized by overactive inflammation and dysregulation of T cells can realize significant clinical benefit from ECP treatments.…”

Some of the Mechanisms of Extracorporeal Photochemotherapy in Solid Organ Transplantation

“…ЭФХТ рекомендована Американским обще-ством афереза в качестве одного из основных мето-дов профилактики отторжения трансплантата серд-ца и легких [6].…”