Isenring Bruno, Robinson Cécile, Buergi Urs, Schuurmans Macé M, Kohler Malcolm, Huber Lars C, Benden Christian
Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
Clin Transplant. 2017 Oct;31(10). doi: 10.1111/ctr.13041. Epub 2017 Aug 1.
Extracorporeal photophoresis (ECP) is an increasingly used therapy to address chronic lung allograft dysfunction (CLAD) following lung transplantation. In 2008, we reported the first single-center experience showing that ECP not only reduces lung function decline in patients with bronchiolitis obliterans syndrome (BOS) but results in stabilization of patients with recurrent acute cellular rejection (ACR). In this study, the original cohort was followed up further 5 years. In addition, patients with CLAD were retrospectively classified according to recently published phenotypes. The current cohort included 21 of the original 24 patients, of which nine were initially treated for CLAD, 12 were initially treated for recurrent ACR. Our results show that survival of patients treated with ECP for CLAD was inferior to patients treated for recurrent ACR (66% vs. 82% survival rate). Long-term survivors in the CLAD subgroup were mostly classified as BOS 1 at time of ECP initiation. These long-term data show that patients started on ECP at early BOS stages have better long-term outcome. The subgroup of ECP patients with recurrent ACR has an overall superior survival. To assist prediction of therapy response, we agree with other authors that patients with CLAD should be aimed to be phenotyped and evaluated for an early treatment with ECP.
体外光化学疗法（ECP）是一种在肺移植后用于治疗慢性肺移植功能障碍（CLAD）的应用日益广泛的疗法。2008年，我们报道了首个单中心经验，表明ECP不仅能减缓闭塞性细支气管炎综合征（BOS）患者的肺功能下降，还能使反复发生急性细胞排斥反应（ACR）的患者病情稳定。在本研究中，对最初的队列进行了5年的进一步随访。此外，根据最近公布的表型对CLAD患者进行了回顾性分类。当前队列包括最初24名患者中的21名，其中9名最初接受CLAD治疗，12名最初接受反复ACR治疗。我们的结果显示，接受ECP治疗的CLAD患者的生存率低于接受反复ACR治疗的患者（生存率分别为66%和82%）。CLAD亚组中的长期存活者在开始ECP治疗时大多被归类为BOS 1期。这些长期数据表明，在BOS早期开始接受ECP治疗的患者有更好的长期预后。反复发生ACR的ECP患者亚组总体生存率更高。为了辅助预测治疗反应，我们同意其他作者的观点，即应对CLAD患者进行表型分析，并评估其是否适合早期接受ECP治疗。
