Extracorporeal photopheresis in heart transplant rejection

Patel, Jignesh; Klapper, Ellen; Shafi, Hedyeh; Kobashigawa, Jon A.

doi:10.1016/j.transci.2015.02.004

Cited by 17 publications

(15 citation statements)

References 15 publications

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“…However, during the last decade acute rejection as indication for re‐transplantation has become an infrequent event. This is related to the fact that refractory acute rejection is rarely seen because of improvements with diagnosis allowing identification of high risk patients, early detection of events and because of improved treatment options like extracorporeal pheresis, the availability of new antibodies and better maintenance immunosuppression . Monitoring immunosuppressive drug intake compliance should be rigidly undertaken; many of the patients with refractory severe rejection had adherence problems with medication and are therefore ineligible for re‐transplantation .…”

Section: Discussionmentioning

confidence: 99%

Heart re-transplantation in Eurotransplant

et al. 2018

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Internationally 3% of the donor hearts are distributed to re-transplant patients. In Eurotransplant, only patients with a primary graft dysfunction (PGD) within 1 week after heart transplantation (HTX) are indicated for high urgency listing. The aim of this study is to provide evidence for the discussion on whether these patients should still be allocated with priority. All consecutive HTX performed in the period 1981-2015 were included. Multivariate Cox' model was built including: donor and recipient age and gender, ischaemia time, recipient diagnose, urgency status and era. The study population included 18 490 HTX, of these 463 (2.6%) were repeat transplants. The major indications for re-HTX were cardiac allograft vasculopathy (CAV) (50%), PGD (26%) and acute rejection (21%). In a multivariate model, compared with first HTX hazards ratio and 95% confidence interval for repeat HTX were 2.27 (1.83-2.82) for PGD, 2.24 (1.76-2.85) for acute rejection and 1.22 (1.00-1.48) for CAV (P < 0.0001). Outcome after cardiac re-HTX strongly depends on the indication for re-HTX with acceptable outcomes for CAV. In contrast, just 47.5% of all hearts transplanted in patients who were re-transplanted for PGD still functioned at 1-month post-transplant. Alternative options like VA-ECMO should be first offered before opting for acute re-transplantation.

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Section: Discussionmentioning

confidence: 99%

Heart re-transplantation in Eurotransplant

et al. 2018

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“…After the first report on the application of extracorporeal photopheresis (ECP) after HTx, the addition of ECP to a standard immunosuppressive drug therapy has been shown to reduce cellular and humoral rejection . Upregulation of regulatory T cells and activation of dendritic cells/cytokines are regarded as the key mechanisms contributing to the method's success . Currently, ECP is recommended for the treatment of antibody‐mediated rejections with evidence of DSAs .…”

Section: Alternative Approachesmentioning

confidence: 99%

“…71,72 Upregulation of regulatory T cells and activation of dendritic cells/cytokines are regarded as the key mechanisms contributing to the method's success. 73 Currently, ECP is recommended for the treatment of antibody-mediated rejections with evidence of DSAs. 74 Thus, ECP might be an adjunctive tool in renal protective strategies for patients with a high immunological risk to minimize or avoid CNIs altogether without losing efficacy.…”

Section: Alternative Approachesmentioning

confidence: 99%

Renal protection strategies after heart transplantation

Reichart¹,

Reichenspurner²,

Barten³

2018

Clinical Transplantation

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Renal dysfunction caused by calcineurin inhibitor (CNI) nephrotoxicity occurs often and contributes significantly to late mortality after heart transplantation (HTx). Over the last decades, this has prompted many clinical studies in an effort to develop kidney-protecting immunosuppressive strategies including delayed CNI start, minimization, withdrawal, or even de novo CNI avoidance. In the past, these strategies often failed due to the lack of efficacy. Since 2009, novel CNI-reducing strategies have been under investigation. These strategies minimize renal damage using induction agents such as antithymocyte globulin and alternative immunosuppressive agents such as the mechanistic target of rapamycin inhibitors (sirolimus or everolimus) or mycophenolate.This review outlines the recent results of using these renal protection strategies including their drawbacks. We also discuss alternative approaches to optimize individual immunosuppressive therapies after HTx. K E Y W O R D Scalcineurin inhibitors, heart transplantation, immunosuppression, mechanistic target of rapamycin inhibitors, nephrotoxicity, renal protecting strategies

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“…It revealed that, after 12 weeks of treatment, the skin score of patients on ECP had a median improvement of 14.5 versus 8.5% in the steroid only group and the ECP-treated patients experienced a substantial reduction in the requirement of corticosteroids [5]. Over the years, ECP has been introduced as new therapeutic option for a large number of other conditions, including sclerosing disorders [6-8], atopic dermatitis [9], and erythroderma of other origin [10, 11], and investigated as a preventive measure to reduce risk of heart [12], lung [13], and kidney [14] transplant rejection.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal Photopheresis: A Case of Immunotherapy Ahead of Its Time

Vieyra-Garcia¹,

Wolf²

2020

Transfus Med Hemother

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Extracorporeal photopheresis (ECP) is a cell-based immunotherapy that involves the reinfusion of autologous leukocytes after exposure to psoralen and UVA. The treatment has been used for over 30 years, at first on patients with cutaneous T-cell lymphoma (CTCL) and later for the management of patients with graft-versus-host disease (GvHD), sclerosing disorders, atopic dermatitis, and other diseases that may share the common driving factor of a pathogenic T-cell clone or clones in blood circulation. Patients with clinical improvement mount an antigen-specific immune response that may have tolerance traits in the case of GvHD or anticlonal cytotoxic characteristics in the case of CTCL. The exact mechanisms that dictate one response or the other are not fully understood, but the evidence accumulated so far indicates that multiple events occur simultaneously and consequentially contribute to the end result. These include contact of cells with the outside (plastics and tubing of the ECP apparatus), exposure to psoralen and UVA that activates platelets, monocytes, and other myeloid cells, the release of damage-associated molecular patterns, differentiation of monocytes into dendritic cells, and generation and successive presentation of numerous antigens after the phagocytosis of apoptotic cells. Once reintroduced, the ECP product increases the frequency and activity of regulatory T cells (Tregs), shifts the systemic cytokine balance, and promotes extravasation of immune cells that together shape the effects of this treatment. In this review, we summarize the seminal work and most recent literature of the therapeutic mechanisms and reflect on future avenues of improvements and applications of ECP.

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Extracorporeal photopheresis in heart transplant rejection

Cited by 17 publications

References 15 publications

Heart re-transplantation in Eurotransplant

Heart re-transplantation in Eurotransplant

Renal protection strategies after heart transplantation

Extracorporeal Photopheresis: A Case of Immunotherapy Ahead of Its Time

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