Extracorporeal Photopheresis in the Treatment of Cardiac Allograft Rejection in the Modern Era: A Single-Center Experience

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-07-23 DOI:10.1111/ctr.70247

Gal Rubinstein, Andrea Fernandez Valledor, Cathrine M. Moeller, Julia Baranowska, Daniel Oren, David Kyung Taek Oh, David Bae, Adil Yunis, Dor Lotan, Afsana Rahman, Jayant K. Raikhelkar, Justin A. Fried, Ersilia M. DeFilippis, Kevin J. Clerkin, Farhana Latif, Gabriel T. Sayer, Nir Uriel

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Abstract

Background

Extracorporeal photopheresis (ECP) has gained recognition as a valuable adjunctive antirejection therapy, particularly in heart-transplantation (HT) patients at elevated risk for rejection or those experiencing recurrent antibody-mediated rejection (AMR) despite appropriate treatment. We evaluated the safety and clinical effects of ECP in HT recipients with high immunologic risk.

Methods

All HT recipients who underwent ECP between February 2020 and January 2024 were included in this retrospective, single-center study.

Results

Fifteen patients who underwent ECP were identified. Twelve patients completed ECP and were followed for a median of 11.2 months (3.9–19.9). The time from transplant to ECP initiation was 5.3 years (1.3–13). The most common indication for ECP was AMR (60%). During ECP, immunosuppression regimens were maintained or de-escalated in 93% of the patients. Reduction in donor specific antibodies (DSA), peripheral gene expression profiling (GEP), and donor-derived cell-free DNA (dd-cfDNA) levels were observed in 64%, 57%, and 67% of the patients, respectively. Eighty-three percent of the patients were free from rejection during the follow-up period. Overall survival was 87%, and no deaths were related to ECP.

Conclusion

In our single-center experience, ECP resulted in a decrease in immunosuppression use, and a reduction in DSA, GEP, and dd-cfDNA levels with a high freedom-from-rejection rate.

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体外光移植术治疗当代异体心脏移植排斥反应：单中心经验

体外光移植术（Extracorporeal photopheresis， ECP）已被认为是一种有价值的辅助抗排斥治疗，特别是在心脏移植（HT）患者中，尽管接受了适当的治疗，但排斥反应风险较高或复发性抗体介导的排斥反应（AMR）。我们评估了ECP在高免疫风险HT患者中的安全性和临床效果。方法2020年2月至2024年1月期间接受ECP治疗的所有HT受体纳入本回顾性单中心研究。结果15例患者行ECP。12例患者完成ECP，随访时间中位数为11.2个月（3.9-19.9）。从移植到ECP启动时间为5.3年（1.3-13年）。ECP最常见的适应症是AMR（60%）。在ECP期间，93%的患者维持或减少免疫抑制方案。供体特异性抗体（DSA）、外周基因表达谱（GEP）和供体来源的无细胞DNA （dd-cfDNA）水平分别在64%、57%和67%的患者中降低。83%的患者在随访期间没有出现排斥反应。总生存率为87%，无与ECP相关的死亡。结论在我们的单中心实验中，ECP导致免疫抑制的使用减少，DSA、GEP和dd-cfDNA水平降低，且排斥自由率高。

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

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.