Robinson Cécile A, Huber Lars, Murer Christian, Schuurmans Macé, Kohler Malcolm, Hofbauer Günther, Benden Christian
Division of Pulmonology, University Hospital Zurich, Switzerland.
Department of Dermatology, University Hospital Zurich, Switzerland.
Swiss Med Wkly. 2017 Mar 13;147:w14429. doi: 10.4414/smw.2017.14429. eCollection 2017.
Extracorporeal photopheresis (ECP) has been reported to be safe and the ultimate treatment option in lung transplant recipients with chronic lung allograft dysfunction (CLAD), the main overall cause of mortality in lung transplant recipients. However, ECP is not reimbursed in selected health jurisdictions, and reimbursement by health insurance providers is a major issue. In Switzerland, ECP is not recognised by the health authorities as a therapy option for CLAD; thus by the end of 2014, ECP had to be stopped in the majority of adult lung transplant recipients cared for at the University Hospital Zurich because of lack of continuous funding.
To describe the outcome of lung transplant recipients after forced cessation of ECP treatment.
We retrospectively analysed outcome of 12 lung transplant recipients undergoing ECP for different phenotypes of CLAD (bronchiolitis obliterans syndrome, restrictive allograft syndrome) at our centre followed-up for 12 months after forced cessation of ECP.
Within the 12 months after treatment cessation, seven patients (58%) died with a median survival of 207 days (range 6-365 days). Lung function (FEV1, forced expiratory volume in 1 second) declined significantly 6 months after ECP cessation (p = 0.003).
Our data support the role of ECP as valuable treatment option in lung transplant recipients with CLAD.
体外光化学疗法（ECP）据报道是安全的，并且是慢性肺移植功能障碍（CLAD）的肺移植受者的最终治疗选择，CLAD是肺移植受者死亡的主要总体原因。然而，在某些卫生辖区，ECP未获报销，而医疗保险提供商的报销是一个主要问题。在瑞士，卫生当局不认可ECP作为CLAD的治疗选择；因此，到2014年底，由于缺乏持续资金，苏黎世大学医院护理的大多数成年肺移植受者不得不停止ECP治疗。
描述强制停止ECP治疗后肺移植受者的结局。
我们回顾性分析了在我们中心接受ECP治疗的12例CLAD不同表型（闭塞性细支气管炎综合征、限制性移植综合征）的肺移植受者在强制停止ECP治疗后12个月的随访结局。
在停止治疗后的12个月内，7例患者（58%）死亡，中位生存期为207天（范围6 - 365天）。ECP停止6个月后，肺功能（FEV1，第1秒用力呼气量）显著下降（p = 0.003）。
我们的数据支持ECP作为CLAD肺移植受者有价值的治疗选择的作用。
