Abstract
Purpose The pediatric heart transplant literature contains little regarding extracorporeal photopheresis (ECP) despite ISHLT guidelines recommending it for recurrent/recalcitrant rejection. ECP is rarely reported by institutions in the pediatric heart transplant study. We report our unique experience with ECP in pediatric heart transplantation. Methods and Materials After IRB approval, data were obtained on heart transplant patients receiving ECP between 1990-2012 who were ≤ 18 yrs of age at the time of transplant. Combined heart/lung transplants were excluded. Noncompliance was determined by the transplant team at the time of clinical care and based on immunosuppression levels. Results Nineteen heart transplant patients underwent 21 courses of ECP. ECP use has been relatively stable since 2003 at 1.5 patients/yr. Median ages at transplant and initial ECP were 12.7 yrs (range 0.3-18.5) and 15.3 yrs (7.3-31), respectively. Only 1 patient was older than 19 yrs at the time of ECP. Median time from transplant to ECP was 1.4 yrs (0.1-12.6). The median ECP duration was 5.8 months (1.9-16.1). Nine patients underwent ECP in the first year after transplant. Indications for ECP included rejection with hemodynamic compromise (HC, 6 patients), rejection without HC (11), and prophylaxis (2). Eleven patients died at a median time of 3.1 yrs after the start of ECP. One- and 3-yr survival was 84% and 53%, respectively. Survival was unaffected by era of transplantation (pre-2003) and ECP use during or after the first year post-transplant. Eleven patients were labelled noncompliant and had a trend towards lower survival of 75% at 1 yr and 18% at 3 yrs (p=0.09, log-rank in comparison to compliant patients). One patient developed PTLD 21 months after finishing ECP and died from infection. No other adverse effects or infectious complications of ECP were noted. Conclusions This case series represents the largest reported experience with ECP in pediatric heart transplantation. ECP appeared to be safe and effective. Noncompliant patients showed a trend towards lower survival than compliant patients despite ECP.
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