Extracorporeal Photopheresis (ECP) in the Management of Chronic Lung Allograft Dysfunction

Abstract

Purpose We aimed to identify clinical predictors of a favorable response to treatment with extracorporeal photopheresis (ECP) in lung transplant (Tx) recipients with CLAD. Methods Lung Tx recipients followed at Barnes-Jewish Hospital treated with ECP for CLAD were retrospectively identified. Patient characteristics, forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were recorded for the 6 month(mo)s prior to and 12 mos after initiation of ECP. FEV1 was plotted vs. time, and a linear regression line was drawn through the data points. The slope (ml/mo) of the linear regression line was compared pre- and post- ECP using the Wilcoxon signed rank test. FEV1 and FVC were recorded as 0 at the time of re-Tx or death. A favorable response was defined as post-ECP FEV1 slope (ml/mo) > 0. Univariate and multivariable logistic regression models were created to identify covariates associated with a favorable response. Results 208 lung Tx recipients treated with ECP for CLAD between 11/1991-4/2017 were identified. During the study period, 16 patients were treated with 2 separate courses of ECP, totaling 223 ECP treatment courses. Recipient, donor and transplant characteristics are listed in Table 1. The median time to initiation of ECP from date of Tx was 1286.0 days (IQR: 646.8-2839.5). The median rate of change in FEV1 was -94.78 ml/mo (-195.88 ∼ -48.24) pre-ECP, and -13.74 ml/mo (-43.04 ∼ 0.98) post-ECP (p 58/223 (26.0%) treatment courses met criteria for a favorable response. Complications developed in 15 (6.7%) patients and were mostly catheter related. In univariate and multivariable logistic regression, none of the covariates (age, gender, primary diagnosis, rate of FEV1 decline pre-ECP, time from Tx, time from BOS diagnosis, RAS, early BOS) were significantly associated with response. Conclusion Over 25% of patients with CLAD had a favorable response with an improvement in FEV1 in the 12 mos after ECP initiation. However, we could not identify clinical predictors of a favorable response.