Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.
Transplant Proc. 2021 Jan-Feb;53(1):296-302. doi: 10.1016/j.transproceed.2020.09.003. Epub 2020 Oct 7.
Survival following lung transplantation (LTx) is limited by the development of chronic lung allograft dysfunction (CLAD), for which there are few effective therapies and no standardized management. Several small studies have demonstrated the effectiveness of extracorporeal photopheresis (ECP) as a therapeutic option for CLAD.
A retrospective descriptive audit of 12 LTx recipients who received rescue ECP for CLAD over 5 years (2013-2018) at the Alfred Hospital, Melbourne, Australia, was completed. Nonresponders to ECP were defined as patients who experienced a 20% decrease in forced expiratory volume (FEV) within 6 weeks of commencing therapy.
Mean time since LTx was 849 days and mean time since diagnosis of CLAD was 131 days. Fifty-eight percent of patients were male (n = 7) and 67% responded to ECP therapy (n = 8). Among responders, the mean (95% confidence interval) decline in FEV pre-ECP was 9.0 mL/day (5-12 mL/day), compared to 1.4 mL/day (0-4 mL/day) post-ECP (P = .01). Among nonresponders, mean (95% confidence interval) decline in FEV was 7.2 mL/day (4-10 mL/day) pre-ECP and 5.0 mL/day (3-7 mL/day) post ECP (P = .2). Nonresponders were more likely to be female (P = .01) and neutropenic (P = .005). Patients with prior exposure to anti-thymocyte globulin had a lowered response to ECP.
Rescue ECP arrested the decline of lung function in 67% of patients with CLAD. Sex, pre-ECP neutrophil count, and exposure to anti-thymocyte globulin may help determine response to ECP. Future clinical trials are needed to confirm this effect, help predict response to therapy, and ultimately guide the placement of ECP in the treatment algorithm for CLAD.
肺移植（LTx）后患者的存活率受到慢性肺移植物功能障碍（CLAD）的限制，目前针对这种疾病，治疗方法有限，也没有标准化的管理方法。一些小型研究已经证实，体外光化学疗法（ECP）作为 CLAD 的一种治疗选择是有效的。
对澳大利亚墨尔本阿尔弗雷德医院在 5 年内（2013-2018 年）接受 ECP 抢救治疗 CLAD 的 12 名 LTx 受者进行回顾性描述性审计。ECP 无应答者定义为开始治疗后 6 周内 FEV 下降 20%的患者。
LTx 后平均时间为 849 天，CLAD 诊断后平均时间为 131 天。58%的患者为男性（n=7），67%的患者对 ECP 治疗有反应（n=8）。在有反应的患者中，FEV 在 ECP 治疗前的平均（95%置信区间）下降为 9.0 mL/天（5-12 mL/天），而 ECP 治疗后的平均（95%置信区间）下降为 1.4 mL/天（0-4 mL/天）（P=.01）。在无反应的患者中，FEV 在 ECP 治疗前的平均（95%置信区间）下降为 7.2 mL/天（4-10 mL/天），而 ECP 治疗后的平均（95%置信区间）下降为 5.0 mL/天（3-7 mL/天）（P=.2）。无反应者更可能为女性（P=.01）和中性粒细胞减少症（P=.005）。有抗胸腺细胞球蛋白暴露史的患者对 ECP 的反应降低。
ECP 抢救治疗使 67%的 CLAD 患者的肺功能下降得到了控制。性别、ECP 治疗前的中性粒细胞计数和抗胸腺细胞球蛋白的暴露可能有助于确定 ECP 的反应。需要进一步的临床试验来证实这一效果，帮助预测对治疗的反应，并最终指导 ECP 在 CLAD 治疗算法中的应用。
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