Rubinstein Gal, Valledor Andrea Fernandez, Moeller Cathrine M, Baranowska Julia, Oren Daniel, Oh David Kyung Taek, Bae David, Yunis Adil, Lotan Dor, Rahman Afsana, Raikhelkar Jayant K, Fried Justin A, DeFilippis Ersilia M, Clerkin Kevin J, Latif Farhana, Sayer Gabriel T, Uriel Nir
Department of Medicine, Division of Cardiology, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA.
University of Barcelona (UB), Barcelona, Spain.
Clin Transplant. 2025 Aug;39(8):e70247. doi: 10.1111/ctr.70247.
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.
All HT recipients who underwent ECP between February 2020 and January 2024 were included in this retrospective, single-center study.
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.
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.
体外光化学疗法（ECP）已被公认为一种有价值的辅助抗排斥疗法，尤其是对于心脏移植（HT）后排斥反应风险较高或尽管接受了适当治疗仍发生复发性抗体介导排斥反应（AMR）的患者。我们评估了ECP在免疫风险高的HT受者中的安全性和临床效果。
本回顾性单中心研究纳入了2020年2月至2024年1月期间接受ECP的所有HT受者。
共确定了15例接受ECP的患者。12例患者完成了ECP，中位随访时间为11.2个月（3.9 - 19.9个月）。从移植到开始ECP的时间为5.3年（1.3 - 13年）。ECP最常见的适应证是AMR（60%）。在ECP期间，93%的患者维持或降低了免疫抑制方案。分别有64%、57%和67%的患者观察到供体特异性抗体（DSA）、外周基因表达谱（GEP）和供体来源的游离DNA（dd-cfDNA）水平降低。83%的患者在随访期间未发生排斥反应。总体生存率为87%，且无死亡与ECP相关。
根据我们单中心的经验，ECP可减少免疫抑制药物的使用，并降低DSA、GEP和dd-cfDNA水平，且排斥反应发生率较低。
