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J Thorac Cardiovasc Surg 1999;117:1063-1069
© 1999 Mosby, Inc.

CARDIOTHORACIC TRANSPLANTATION

ADJUVANT TREATMENT OF REFRACTORY LUNG TRANSPLANT REJECTION WITH EXTRACORPOREAL PHOTOPHERESIS

From the University of Minnesota Departments of Surgery and Medicine, Divisions of Cardiovascular and Thoracic Surgery and Pulmonary Medicine, Minneapolis, Minn.

Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.

Received for publication June 30, 1998. Revisions requested Nov 19, 1998. Revisions received Jan 25, 1999. Accepted for publication Jan 25, 1999. Address for reprints: Christopher T. Salerno, MD, Department of Surgery, University of Minnesota Hospital and Clinics, 420 Delaware St SE, UMHC Box 207, Minneapolis, MN 55455. J Thorac Cardiovasc Surg 1999;117:1063-9

Background: Extracorporeal photopheresis is an immunomodulatory technique in which a patient's leukocytes are exposed to ultraviolet-A light after pretreatment with 8-methoxypsoralen (methoxsalen). There have been few reports describing the use of extracorporeal photopheresis in lung transplant recipients.
Methods: We reviewed our experience using extracorporeal photopheresis in 8 lung transplant recipients since 1992. All 8 patients had progressively decreasing graft function and 7 were in bronchiolitis obliterans syndrome grade 3 before the initiation of photopheresis. One patient had undergone a second transplant operation for obliterative bronchiolitis. Two patients had a pretransplantation diagnosis of chronic obstructive pulmonary disease, 1 ₁-antitrypsin deficiency, 1 cystic fibrosis, 1 bronchiectasis, 1 idiopathic pulmonary fibrosis, and 2 primary pulmonary hypertension. Before refractory rejection developed, all patients had been treated with 3-drug immunosuppression and anti-T-cell therapy. The median time from transplantation to the start of extracorporeal photopheresis was 16.5 months and the median number of treatments was 6.
Results: The condition of 5 of 8 patients subjectively improved after extracorporeal photopheresis therapy. In these 5 patients photopheresis was associated with stabilization of the forced expiratory volume in 1 second. In 2 patients there was histologic reversal of rejection after photopheresis. With a median follow-up of 36 months, 7 patients are alive and well. Three patients required retransplantation at a median of 21 months after completion of the treatments. Four patients have remained in stable condition after photopheresis. There were no complications related to extracorporeal photopheresis.
Conclusion: We believe that this treatment is a safe option for patients with refractory lung allograft rejection when increased immunosuppression is contraindicated or ineffective. (J Thorac Cardiovasc Surg 1999;117:1063-9)

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