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Original article

Vol. 147 No. 1112 (2017)

Cessation of extracorporeal photopheresis in chronic lung allograft dysfunction: effects on clinical outcome in adults

DOI
https://doi.org/10.4414/smw.2017.14429
Cite this as:
Swiss Med Wkly. 2017;147:w14429
Published
13.03.2017

Summary

BACKGROUND

Extracorporeal photopheresis (ECP) has been reported to be safe and the ultimate treatment option in lung transplant recipients with chronic lung allograft dysfunction (CLAD), the main overall cause of mortality in lung transplant recipients. However, ECP is not reimbursed in selected health jurisdictions, and reimbursement by health insurance providers is a major issue. In Switzerland, ECP is not recognised by the health authorities as a therapy option for CLAD; thus by the end of 2014, ECP had to be stopped in the majority of adult lung transplant recipients cared for at the University Hospital Zurich because of lack of continuous funding.

OBJECTIVE

To describe the outcome of lung transplant recipients after forced cessation of ECP treatment.

METHOD

We retrospectively analysed outcome of 12 lung transplant recipients undergoing ECP for different phenotypes of CLAD (bronchiolitis obliterans syndrome, restrictive allograft syndrome) at our centre followed-up for 12 months after forced cessation of ECP.

RESULTS

Within the 12 months after treatment cessation, seven patients (58%) died with a median survival of 207 days (range 6–365 days). Lung function (FEV1, forced expiratory volume in 1 second) declined significantly 6 months after ECP cessation (p = 0.003).

CONCLUSION

Our data support the role of ECP as valuable treatment option in lung transplant recipients with CLAD.

References

  1. Verleden GM, Vos R, Verleden SE, De Wever W, De Vleeschauwer SI, Willems-Widyastuti A, et al. Survival determinants in lung transplant patients with chronic allograft dysfunction. Transplantation. 2011;92(6):703–8. https://doi.org/10.1097/TP.0b013e31822bf790
  2. Greer M, Dierich M, De Wall C, Suhling H, Rademacher J, Welte T, et al. Phenotyping established chronic lung allograft dysfunction predicts extracorporeal photopheresis response in lung transplant patients. Am J Transplant. 2013;13(4):911–8. https://doi.org/10.1111/ajt.12155
  3. Yusen RD, Christie JD, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, et al.; International Society for Heart and Lung Transplantation. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Adult Lung and Heart-Lung Transplant Report--2013; focus theme: age. J Heart Lung Transplant. 2013;32(10):965–78. https://doi.org/10.1016/j.healun.2013.08.007
  4. Meyer KC, Raghu G, Verleden GM, Corris PA, Aurora P, Wilson KC, et al.; ISHLT/ATS/ERS BOS Task Force Committee; ISHLT/ATS/ERS BOS Task Force Committee. An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome. Eur Respir J. 2014;44(6):1479–503. https://doi.org/10.1183/09031936.00107514
  5. Benden C, Speich R, Hofbauer GF, Irani S, Eich-Wanger C, Russi EW, et al. Extracorporeal photopheresis after lung transplantation: a 10-year single-center experience. Transplantation. 2008;86(11):1625–7. https://doi.org/10.1097/TP.0b013e31818bc024
  6. Morrell MR, Despotis GJ, Lublin DM, Patterson GA, Trulock EP, Hachem RR. The efficacy of photopheresis for bronchiolitis obliterans syndrome after lung transplantation. J Heart Lung Transplant. 2010;29(4):424–31. https://doi.org/10.1016/j.healun.2009.08.029
  7. Meloni F, Cascina A, Miserere S, Perotti C, Vitulo P, Fietta AM. Peripheral CD4(+)CD25(+) TREG cell counts and the response to extracorporeal photopheresis in lung transplant recipients. Transplant Proc. 2007;39(1):213–7. https://doi.org/10.1016/j.transproceed.2006.10.227
  8. Maeda A, Schwarz A, Kernebeck K, Gross N, Aragane Y, Peritt D, et al. Intravenous infusion of syngeneic apoptotic cells by photopheresis induces antigen-specific regulatory T cells. J Immunol. 2005;174(10):5968–76. https://doi.org/10.4049/jimmunol.174.10.5968
  9. Lamioni A, Parisi F, Isacchi G, Giorda E, Di Cesare S, Landolfo A, et al. The immunological effects of extracorporeal photopheresis unraveled: induction of tolerogenic dendritic cells in vitro and regulatory T cells in vivo. Transplantation. 2005;79(7):846–50. https://doi.org/10.1097/01.TP.0000157278.02848.C7
  10. Jaksch P, Scheed A, Keplinger M, Ernst MB, Dani T, Just U, et al. A prospective interventional study on the use of extracorporeal photopheresis in patients with bronchiolitis obliterans syndrome after lung transplantation. J Heart Lung Transplant. 2012;31(9):950–7. https://doi.org/10.1016/j.healun.2012.05.002
  11. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al.; ATS/ERS Task Force. Standardisation of spirometry. Eur Respir J. 2005;26(2):319–38. https://doi.org/10.1183/09031936.05.00034805
  12. Meyer KC, Raghu G, Verleden GM, Corris PA, Aurora P, Wilson KC, et al.; ISHLT/ATS/ERS BOS Task Force Committee; ISHLT/ATS/ERS BOS Task Force Committee. An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome. Eur Respir J. 2014;44(6):1479–503. https://doi.org/10.1183/09031936.00107514
  13. O’Hagan AR, Stillwell PC, Arroliga A, Koo A. Photopheresis in the treatment of refractory bronchiolitis obliterans complicating lung transplantation. Chest. 1999;115(5):1459–62. https://doi.org/10.1378/chest.115.5.1459
  14. Salerno CT, Park SJ, Kreykes NS, Kulick DM, Savik K, Hertz MI, et al. Adjuvant treatment of refractory lung transplant rejection with extracorporeal photopheresis. J Thorac Cardiovasc Surg. 1999;117(6):1063–9. https://doi.org/10.1016/S0022-5223(99)70241-2
  15. Jaksch P, Knobler R. ECP and solid organ transplantation. Transfus Apheresis Sci. 2014;50(3):358–62. https://doi.org/10.1016/j.transci.2014.04.006
  16. Inci I, Schuurmans MM, Boehler A, Weder W. Zurich University Hospital lung transplantation programme: update 2012. Swiss Med Wkly. 2013;143:w13836. https://doi.org/10.4414/smw.2013.13836

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