Extracorporeal Photopheresis in the Treatment of Cardiac Allograft Rejection in the Modern Era: A Single-Center Experience.

BACKGROUND

Extracorporeal photopheresis (ECP) has gained recognition as a valuable adjunctive antirejection therapy, particularly in heart-transplantation (HT) patients at elevated risk for rejection or those experiencing recurrent antibody-mediated rejection (AMR) despite appropriate treatment. We evaluated the safety and clinical effects of ECP in HT recipients with high immunologic risk.

METHODS

All HT recipients who underwent ECP between February 2020 and January 2024 were included in this retrospective, single-center study.

RESULTS

Fifteen patients who underwent ECP were identified. Twelve patients completed ECP and were followed for a median of 11.2 months (3.9-19.9). The time from transplant to ECP initiation was 5.3 years (1.3-13). The most common indication for ECP was AMR (60%). During ECP, immunosuppression regimens were maintained or de-escalated in 93% of the patients. Reduction in donor specific antibodies (DSA), peripheral gene expression profiling (GEP), and donor-derived cell-free DNA (dd-cfDNA) levels were observed in 64%, 57%, and 67% of the patients, respectively. Eighty-three percent of the patients were free from rejection during the follow-up period. Overall survival was 87%, and no deaths were related to ECP.

CONCLUSION

In our single-center experience, ECP resulted in a decrease in immunosuppression use, and a reduction in DSA, GEP, and dd-cfDNA levels with a high freedom-from-rejection rate.