Extracorporeal Photopheresis in Lung Transplantation

Abstract

Extracorporeal photopheresis (ECP) is based on UV irradiation of peripheral leucocytes. It has been proposed for the treatment of chronic lung allograft dysfunction (CLAD). The aim of this study was to evaluate the effect of ECP on respiratory function progression in a cohort of CLAD patients at a single institution and to identify factors associated with positive response to ECP. Twenty-five lung transplant patients (13 men and 12 women, median age at transplant 51 years) were enrolled; clinical and functional data was collected retrospectively. Overall, pulmonary function tests showed a statistically significant improvement in the rate of decline of FEV1, FVC and FEV1/VC after introduction of ECP. Forty-four percentage of patients showed a <10% decline in FEV1 and were classified as responders to ECP therapy. FEV1 after 3 months of ECP seemed a sufficient criterion to define responders. Patients with recurrent respiratory infections and those with a BOS/RAS mixed phenotype showed less probability of responding to ECP. ECP had a positive impact on survival: responders showed longer median survival (1685 vs. 316 days). Our study confirms that ECP therapy reduces respiratory function decline and improves survival in CLAD patients with a response rate of about 50%. Although a clear clinical profile of responders patients has yet to emerge, BOS phenotype, onset of CLAD within 3 years of transplant and absence of recurrent respiratory infections seem to be associated with a positive response to ECP therapy.