Extracorporeal Photopheresis, a Therapeutic Alternative for T cell-mediated Rejection in Renal Transplantation

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-01-01 DOI:10.1016/j.transproceed.2024.11.028

Mercedes de Lara Gil , Mercedes Gil Muñoz , Elena de Lara Gil , Miguel Blanquer , Santiago Llorente Viñas , Francisco Morales Caravaca , Isabel Saura Luján , Juan Bautista Cabezuelo Romero

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引用次数: 0

Abstract

T-cell mediated rejection (TCMR) in renal transplantation, although reduced by better immunosuppressants, still impacts graft survival. TCMR responds to methylprednisolone (MPL) in 60% to 70% of cases, with polyclonal anti-T-lymphocyte antibodies (ATGs) used for severe or corticoresistant cases. When ATG is contraindicated, extracorporeal photopheresis (ECP) may be an alternative. ECP involves treating immune cells with 8-methoxypsoralen and ultraviolet-A radiation before reinjection, with effect in various T-cell-mediated and autoimmune diseases.

This study included two renal transplant recipients with severe TCMR. Patient 1’s creatinine levels were 1.4 mg/dL baseline, 2.2 mg/dL at TCMR diagnosis, and 1.9 mg/dL at ECP initiation. Patient 2’s levels were 1 mg/dL baseline, 1.8 mg/dL at diagnosis, and 1.42 mg/dL at ECP initiation. The THERAKOS CELLEX system was used for patient 1, and the OPTIA system was used for patient 2, both with methoxsalen. ECP is highlighted as a viable option for TCMR in renal transplantation when conventional treatments are unsuitable.

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体外光移植术：治疗肾移植中T细胞介导的排斥反应的一种替代方法。

肾移植中t细胞介导的排斥反应（TCMR）虽然可以通过更好的免疫抑制剂来降低，但仍然影响移植物的存活。在60%至70%的病例中，甲基强的松龙（MPL）对TCMR有应答，多克隆抗t淋巴细胞抗体（ATGs）用于严重或皮质耐药病例。当ATG是禁忌时，体外光疗（ECP）可能是一种替代方法。ECP包括在再注射前用8-甲氧基补骨脂素和紫外线- a辐射治疗免疫细胞，对各种t细胞介导的自身免疫性疾病有效。本研究包括两名严重TCMR的肾移植受者。患者1的肌酐水平基线为1.4 mg/dL， TCMR诊断时为2.2 mg/dL， ECP开始时为1.9 mg/dL。患者2基线水平为1mg /dL，诊断时为1.8 mg/dL， ECP开始时为1.42 mg/dL。患者1使用THERAKOS celllex系统，患者2使用OPTIA系统，均使用甲氧沙林。当常规治疗不适合时，ECP被强调为TCMR在肾移植中的可行选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.