European multicenter study on the real-world use and clinical impact of extracorporeal photopheresis after heart transplantation

https://doi.org/10.1016/j.healun.2023.03.005Get rights and content
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Background

Aim of this study was to describe the real-world use of extracorporeal photopheresis (ECP) and assess its impact on clinical outcomes in the modern era of heart transplantation.

Methods

Seven transplant centers from 5 European countries participated in this retrospective, observational, single-arm chart review study. All patients received ECP after heart transplantation in 2015 or later. Data were extracted from medical records between November 2020 and December 2021.

Results

Overall, 105 patients were enrolled and followed for an average of 2 years after initiation of ECP. Reasons to start ECP were acute cellular rejection (35.2%), rejection prevention (32.4%), mixed rejection (18.1%), and antibody-mediated rejection (14.3%). Rejection ISHLT grades improved from start to end of ECP treatment in 92% of patients treated with ECP for rejection. Of patients who started ECP to prevent rejection, 88% remained free from any rejection despite a reduction of calcineurin inhibitors. Overall survival was 95%, and no deaths were related to ECP. Safety events occurred in 18 patients, of which 13 experienced complications with venous access.

Conclusions

This study, the largest European ECP study in heart transplantation, demonstrates that ECP can effectively be used to treat different rejection types and to prevent rejection in the modern era of immunosuppression. Patients with rejections who have received ECP have shown high response as measured by histological improvements in ISHLT classification. A high percentage of patients in the prevention group remained free from rejection despite reduction in immunosuppression, in particular calcineurin inhibitors.

KEYWORDS

heart transplantation
rejection
prevention
extracorporeal photopheresis
observational

Abbreviations

ACR
Acute cellular rejection
AMR
Antibody-mediated rejection
CAV
Cardiac allograft vasculopathy
CMV
Cytomegalovirus
DSA
Donor-specific antibodies
EBV
Epstein-Barr virus
ECP
Extracorporeal photopheresis
GDPR
European General Data Protection Regulation
HTx
Heart transplantation
ISHLT
International Society of Heart and Lung Transplantation
SD
Standard deviation

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