Expanding Horizons: Single-Center Insights on Extracorporeal Photopheresis (ECP) in Non-Lung Solid Organ Transplantation

Abstract

Transplantation remains the best option for patients with advanced-stage organ failure. In some patients, despite aggressive medical management with immunosuppressants, refractory/recurrent rejection occurs. This single-center retrospective study aims to analyze the role of ECP as an add-on therapy to treat acute cellular rejection (ACR) and/or antibody-mediated rejection (AMR) in non-lung organ transplantation. We identified five non-lung solid organ transplant (SOT) recipients refractory to standard anti-rejection interventions that received ECP therapy in the last 5 years: one liver transplant, two heart transplants, and two small bowel transplants. Baseline demographics, time to ECP initiation, clinical assessment, and biopsy results were analyzed. They received at least 6 months of ECP for biopsy-proven ACR and/or AMR. Graft function was assessed clinically after 6 months by biopsy and/or clinical functional assessment. Graft function improved in all five patients after 6 months of ECP therapy based on clinical functional evaluation and by biopsy in some patients. No complications or adverse events were reported. This study supports the potential for ECP as an adjunctive therapy in non-lung organ transplant recipients who are refractory to standard therapies and present with ACR and/or AMR. ECP has immunomodulating effect with minimal procedural risk. Prospective studies are warranted to confirm the beneficial effects of ECP in the setting of ACR and AMR post organ transplantation.