Extracorporeal Photopheresis (ECP) in Kidney Allograft Recipients: 1-Year Followup

Abstract

Background: ECP is considered a promising immunomodulatory therapy used for treatment of acute allograft rejection in solid organ transplant patients (pts) and GVHD. We report on early results of cadaver KTx in 20 paired recipients, all of them on standard immunosuppression (MPA+CNI+prednisone), and 10 of them additionally treated with 12-16 ECP procedures in the first 3 months (M) following KTx. Methods: There was no significant differences between controls and ECP group in term of age (47 11 vs 43,4 13y), gender of pts (3 vs 4 F), cause of end stage kidney disease, cold ischemia time, diabetes, hypertension, CsA/TAC concentrations, MPA dose, BMI (24,8 2 vs 26,2 5), mean HLA mismatch (2,6 vs 2,75) and sensitization. ECP procedures were conducted using UVAR XTS (Therakos, Exton, PA), an automated system for leukocyte separation and photoactivation (with injection of Methoxsalen). All pts were followed by means of eGFR and peripheral WBCs, T-cell,B,NK, Treg, DCs counts and phenotype. Results: In ECP group a positive tendency to higher GFR at M 6 (67,5 ±10 vs 53,6± 3; p=0.03) and M 12 (64,4 ±8 vs 59,5± 3; p=0.09 in Wilcoxon test) was observed. Transplant related complications are summarized in table1. All rejections (all cellular) were successfully treated with steroid pulse in both groups. One recipient from ECP group who experienced rejection have had unstable CNI levels in the first 6 months and might not response to ECP due to permanent low number of WBCs.Table: [Transplant related complications]Conclusions: An addition of ECP to standard immunosuppression in the first post-KTx year was associated with favorable kidney allograft function and less opportunistic infections. Acute rejections in ECP treated recipients appeared after 6 M and were reversible.