Kusztal M, Kłak R, Krajewska M, Boratyńska M, Patrzałek D, Klinger M
Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wroclaw, Poland.
Transplant Proc. 2011 Oct;43(8):2941-2. doi: 10.1016/j.transproceed.2011.08.034.
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.
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).
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.
体外光化学疗法（ECP）被认为是一种有前景的免疫调节疗法，用于治疗由异常T淋巴细胞引起的疾病。ECP已用于移植物抗宿主病和系统性硬化症患者以及实体器官排斥反应。在此，我们报告了对10例肾移植受者进行148次ECP治疗的经验（每位患者进行12 - 19次治疗）。在2例患者中，因类固醇抵抗性排斥发作而采用ECP，在8例患者中，ECP作为移植后前3个月标准免疫抑制治疗之外的支持性治疗。ECP治疗使用UVAR XTS设备（Therakos公司，埃克斯顿，宾夕法尼亚州），这是一种用于白细胞分离和用甲氧沙林进行光激活（紫外线A）的自动化封闭系统。
血管通路为动静脉内瘘（n = 99）、永久导管（n = 16）、外周静脉（n = 25）或聚四氟乙烯移植物（n = 8）。平均血流速度为35.5±5 mL/分钟。单次ECP治疗持续175.5±35分钟（范围为120 - 277分钟），包括光激活（33.3±30分钟）。每次治疗的处理血量（血沉棕黄层）为228.4±34 mL。每次治疗给予的总液体量为449.5±60 mL，平均肝素剂量为5979±530 IU。与ECP相关的副作用包括短暂性肌张力减退（n = 2）、体温升高（最高达37.5°C；n = 4）以及因采血袋凝血或再输注技术问题导致的红细胞丢失（约100 mL；n = 3）。
所有移植受者均成功建立了ECP的血管通路，甚至包括外周静脉。肾移植受者对与ECP相关的副作用耐受性较好。对于液体受限（约450 mL生理盐水输注）或有抗凝出血风险的患者必须谨慎。
