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A European Multi-Center Analysis of Extracorporeal Photopheresis as Therapy for Chronic Lung Allograft Dysfunction

Authors :
Alberto Benazzo
Cecilia Bagnera
Fabio Ius
Claudia Del Fante
Jens Gottlieb
Konrad Hoetzenecker
Federica Meloni
Peter Jaksch
Mark Greer
Source :
Transplant International, Vol 36 (2024)
Publication Year :
2024
Publisher :
Frontiers Media S.A., 2024.

Abstract

Extracorporeal photopheresis (ECP) is used by few lung transplant centers to treat chronic lung allograft dysfunction (CLAD). Although reported results suggest a beneficial effect on CLAD progression, evidence is limited to single center experiences. The aim of this study is to analyze outcomes of ECP in a large multicenter European cohort. The primary endpoint was patient survival after initiation of ECP. This study included 631 patients, 87% suffered from bronchiolitis obliterans syndrome (BOS), and 13% had restrictive allograft syndrome (RAS). Long-term stabilization was achieved in 42%, improvement in 9%, and no response in 26%. Within the first 12 months of therapy, 23% of patients died. Patients’ survival after initiation of ECP at 5 years was 56% in stable, 70% in responders, and 35% in non-responders (p = 0.001). In multivariable Cox regression, both stabilization (HR: 0.48, CI: 0.27–0.86, p = 0.013) and response (HR: 0.11, CI: 0.04–0.35, p < 0.001) to ECP were associated with survival. Absolute FEV1 at baseline was also protective (HR: 0.09, CI: 0.01–0.94, p = 0.046). RAS phenotype was the only risk factor for mortality (HR: 2.11, 1.16–3.83, p = 0.006). This study provides long-term outcomes of ECP use in CLAD patients in the largest published cohort to date. Two-thirds of the cohort had a sustained response to ECP with excellent long-term results.

Details

Language :
English
ISSN :
14322277
Volume :
36
Database :
Directory of Open Access Journals
Journal :
Transplant International
Publication Type :
Academic Journal
Accession number :
edsdoj.9333c0dac1490ca50c2433d887a6a2
Document Type :
article
Full Text :
https://doi.org/10.3389/ti.2023.11551