Department of Respirology, Strasbourg Lung Transplant Program, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, Strasbourg F - 67000, France.
Clinical Transplantation Laboratory, Établissement Français du Sang Grand-Est, Strasbourg, France.
Respir Med Res. 2022 May;81:100913. doi: 10.1016/j.resmer.2022.100913. Epub 2022 Apr 26.
Bronchiolitis obliterans syndrome (BOS) is the main limitation to long-term survival following lung transplantation. Several studies generated promising results regarding the efficacy of extracorporeal photopheresis (ECP) in BOS management. We aimed to compare FEV1 evolution in ECP-treated versus non-ECP treated patients among BOS recipients.
Overall, 25 BOS patients were included after receiving optimized treatment. Data were collected retrospectively. Twelve patients with moderate and refractory BOS received ECP treatment.
Among non-ECP treated control patients (n = 13), six experienced persistent decline without undergoing ECP for various reasons. ECP stabilized pre-ECP lung function during the subsequent 6 to 24 months (repeated measures one-way Anova, p = 0.002), without any significant impact observed by either FEV1 decline speed prior to ECP or time between BOS diagnosis and ECP onset. ECP-treated patients displayed a similar risk of an additional permanent 20% or higher drop in FEV1 after BOS onset compared to controls, but a lower risk compared to control decliners (p = 0.05). ECP quickly stabilized FEV1 decline in refractory BOS patients compared to non-treated decliners.
We confirmed that this therapeutic option against refractory BOS can be managed in a medium-size LTx center, with a satisfactory efficacy and an acceptable tolerance.
闭塞性细支气管炎综合征（BOS）是肺移植后长期生存的主要限制因素。几项研究表明，体外光化学疗法（ECP）在 BOS 管理中的疗效有一定前景。我们旨在比较 ECP 治疗与非 ECP 治疗的 BOS 患者的 1 秒用力呼气量（FEV1）变化。
总共纳入了 25 名接受优化治疗后的 BOS 患者。数据进行了回顾性收集。12 名中度和难治性 BOS 患者接受了 ECP 治疗。
在未接受 ECP 治疗的对照组患者（n=13）中，有 6 名患者因各种原因未接受 ECP 治疗而持续下降。ECP 在随后的 6 至 24 个月稳定了 ECP 前的肺功能（重复测量单向方差分析，p=0.002），在接受 ECP 治疗前的 FEV1 下降速度或 BOS 诊断与 ECP 开始之间的时间方面，没有观察到任何显著影响。与对照组相比，ECP 治疗组患者在 BOS 发病后出现 FEV1 额外永久性下降 20%或更高的风险相似，但与对照组下降者相比，风险较低（p=0.05）。与未经治疗的下降者相比，ECP 可迅速稳定难治性 BOS 患者的 FEV1 下降。
我们证实了这种针对难治性 BOS 的治疗选择可以在中等规模的 LTx 中心管理，具有令人满意的疗效和可接受的耐受性。
