Application of Extracorporeal Photopheresis in Kidney Transplant Recipients: Technical Considerations and Procedure Tolerance

Abstract

Background Extracorporeal photopheresis (ECP) is considered to be a promising immunomodulatory therapy in diseases caused by aberrant T lymphocytes. ECP has been used in patients with graft-versus-host disease and systemic scleroderma as well as in solid organ rejection. Herein we report our experience with 148 ECP procedures performed in 10 kidney transplant recipients (12–19 sessions per patient). In 2 subjects, ECP was introduced because of a steroid-resistant rejection episode, and in 8 as supportive treatment in addition to standard immunosuppression in the first 3 months after transplantation. ECP procedures were performed using the UVAR XTS device (Therakos, Exton, PA), an automated closed system for white blood cell separation and photoactivation (ultraviolet light A) with methoxsalen. Results Vascular access was arteriovenous fistula (n = 99), permanent catheter (n = 16), peripheral vein (n = 25), or polytetrafluoroethylene graft (n = 8). Mean blood flow rate was 35.5 ± 5 mL/min. Single ECP procedures lasted 175.5 ± 35 min (range, 120–277), including photoactivation (33.3 ± 30 min). Treatment volume (buffy coat) was 228.4 ± 34 mL per session. Total fluids administered per session were 449.5 ± 60 mL, and mean heparin dose was 5,979 ± 530 IU. ECP-related side effects were transient hypotonia (n = 2), increased body temperature (up to 37.5°C; n = 4) and red blood cell loss due to a clotted kit or a technical problem with reinfusion (∼100 mL; n = 3). Conclusions Vascular access for ECP was established in all transplant recipients, using even peripheral veins. Side effects associated with ECP were fairly tolerable by kidney allograft recipients. Caution must be paid to patients with fluid restriction (∼450 mL saline infusion) or the risk of bleeding due to anticoagulation.