BACKGROUND: Photopheresis therapy (photo) has been advocated as a therapy to improve outcome after recalcitrant or severe rejection, but objective evidence of a beneficial effect has been elusive. This study examined the hypothesis that photo provides protection against rejection, rejection with hemodynamic compromise (HC), and death from rejection after cardiac transplantation. METHODS: Between 1990 and 2003, 36 adult patients (from 343 adult transplant recipients) received at least 3 months of photo (2-day treatment every 3 to 6 weeks for a target of 18 months) after HC rejection (n = 12), recurrent/recalcitrant rejection (n = 20), or as prophylaxis in the presence of anti-donor antibodies (n = 4). Survival and risk factors were examined by analysis using multivariate hazard function modulated renewal function. RESULTS: Patients selected for photo were at greater risk for rejection (p < 0.0001) and HC rejection (p < 0.0001) than non-photo patients. After 3 months of photo therapy, rejection risk was decreased (p = 0.04). More importantly, the hazard for subsequent HC rejection or rejection death was significantly reduced toward the risk-adjusted level of lower-risk non-photo patients (p = 0.006). CONCLUSIONS: This study provides objective evidence that photo reduces the risk of subsequent HC rejection and/or death from rejection when initiated for patients with high rejection risk. Photopheresis is recommended as an important therapeutic modality after rejection with hemodynamic compromise, although further studies are needed to define the precise mechanism of the effect and the potential for benefit in other patient sub-sets.
BACKGROUND: Photopheresis therapy (photo) has been advocated as a therapy to improve outcome after recalcitrant or severe rejection, but objective evidence of a beneficial effect has been elusive. This study examined the hypothesis that photo provides protection against rejection, rejection with hemodynamic compromise (HC), and death from rejection after cardiac transplantation. METHODS: Between 1990 and 2003, 36 adult patients (from 343 adult transplant recipients) received at least 3 months of photo (2-day treatment every 3 to 6 weeks for a target of 18 months) after HC rejection (n = 12), recurrent/recalcitrant rejection (n = 20), or as prophylaxis in the presence of anti-donor antibodies (n = 4). Survival and risk factors were examined by analysis using multivariate hazard function modulated renewal function. RESULTS:Patients selected for photo were at greater risk for rejection (p < 0.0001) and HC rejection (p < 0.0001) than non-photo patients. After 3 months of photo therapy, rejection risk was decreased (p = 0.04). More importantly, the hazard for subsequent HC rejection or rejection death was significantly reduced toward the risk-adjusted level of lower-risk non-photo patients (p = 0.006). CONCLUSIONS: This study provides objective evidence that photo reduces the risk of subsequent HC rejection and/or death from rejection when initiated for patients with high rejection risk. Photopheresis is recommended as an important therapeutic modality after rejection with hemodynamic compromise, although further studies are needed to define the precise mechanism of the effect and the potential for benefit in other patient sub-sets.
Authors: R Knobler; G Berlin; P Calzavara-Pinton; H Greinix; P Jaksch; L Laroche; J Ludvigsson; P Quaglino; W Reinisch; J Scarisbrick; T Schwarz; P Wolf; P Arenberger; C Assaf; M Bagot; M Barr; A Bohbot; L Bruckner-Tuderman; B Dreno; A Enk; L French; R Gniadecki; H Gollnick; M Hertl; C Jantschitsch; A Jung; U Just; C-D Klemke; U Lippert; T Luger; E Papadavid; H Pehamberger; A Ranki; R Stadler; W Sterry; I H Wolf; M Worm; J Zic; C C Zouboulis; U Hillen Journal: J Eur Acad Dermatol Venereol Date: 2014-01 Impact factor: 6.166
Authors: Jon Kobashigawa; Maria G Crespo-Leiro; Stephan M Ensminger; Hermann Reichenspurner; Annalisa Angelini; Gerald Berry; Margaret Burke; Lawrence Czer; Nicola Hiemann; Abdallah G Kfoury; Donna Mancini; Paul Mohacsi; Jignesh Patel; Naveen Pereira; Jeffrey L Platt; Elaine F Reed; Nancy Reinsmoen; E Rene Rodriguez; Marlene L Rose; Stuart D Russell; Randy Starling; Nicole Suciu-Foca; Jose Tallaj; David O Taylor; Adrian Van Bakel; Lori West; Adriana Zeevi; Andreas Zuckermann Journal: J Heart Lung Transplant Date: 2011-03 Impact factor: 10.247
Authors: Octavio E Pajaro; Dawn E Jaroszewski; Robert L Scott; Anantharam V Kalya; Henry D Tazelaar; Francisco A Arabia Journal: J Transplant Date: 2011-12-06
Authors: Arun Alfred; Peter C Taylor; Fiona Dignan; Khaled El-Ghariani; James Griffin; Andrew R Gennery; Denise Bonney; Emma Das-Gupta; Sarah Lawson; Ram K Malladi; Kenneth W Douglas; Tracey Maher; Julie Guest; Laura Hartlett; Andrew J Fisher; Fiona Child; Julia J Scarisbrick Journal: Br J Haematol Date: 2017-02-21 Impact factor: 6.998