Article Impact Level: HIGH Data Quality: STRONG Summary of European Respiratory Journal, 2400733. https://doi.org/10.1183/13993003.00733-2024 Dr. Alberto Benazzo et al.
Points
- The study assessed extracorporeal photopheresis (ECP) as a prophylactic treatment for acute cellular rejection (ACR), CMV infections, and chronic lung allograft dysfunction (CLAD) in lung transplant recipients.
- The ECP group showed significantly lower rates of reaching the composite endpoint (19.4% vs. 61.3%, p<0.001) and higher freedom from high-grade ACR (p=0.045), with reduced cumulative ACR scores at 3 and 12 months.
- ECP-treated patients had fewer infections (5 cases vs. 22 cases) and significantly shorter hospital stays (67 days vs. 309 days, p=0.002).
- Freedom from CLAD at three years was significantly greater in the ECP group compared to the control group (p=0.015).
- Adding ECP to standard immunosuppressive therapy reduces ACR, CLAD incidence, and infection burden in lung transplant recipients.
Summary
This study aimed to evaluate the effectiveness of extracorporeal photopheresis (ECP) as a prophylactic treatment for acute cellular rejection (ACR), CMV infections, and chronic lung allograft dysfunction (CLAD) in lung transplant recipients. The study was conducted between 2018 and 2020 at the Medical University of Vienna and included 31 chronic obstructive pulmonary disease (COPD) lung transplant recipients per group. The treatment group received ECP in addition to standard triple-drug immunosuppression, while the control group received only the standard immunosuppression. The primary endpoint was a composite measure that included the incidence of high-grade ACR, CMV infection, or CLAD within 24 months post-transplant.
Results demonstrated a significant benefit of ECP treatment. In the control group, 61.3% of patients (19/31) reached the primary endpoint, compared to only 19.4% (6/31) in the treatment group (p<0.001). Additionally, freedom from high-grade ACR was significantly higher in the ECP group (p=0.045). The cumulative ACR scores at 3 months were lower in the ECP group (0.18±0.44) compared to the control group (0.56±0.94, p<0.05), with a similar reduction observed at 12 months (0.25±0.48 vs. 1.0±1.45, p=0.002). The ECP group also experienced fewer infections, with only 5 cases and 67 cumulative hospital days, compared to 22 cases and 309 days in the control group (p=0.002).
Moreover, freedom from CLAD at three years was significantly greater in the ECP group (p=0.015). These findings indicate that adding ECP to the standard immunosuppressive regimen significantly reduces the incidence of ACR and CLAD and is associated with a lower infection burden in lung transplant recipients.
Link to the article: https://publications.ersnet.org/content/erj/early/2024/10/10/1399300300733-2024
References Benazzo, A., Cho, A., Auner, S., Schwarz, S., Kovacs, Z., Ramazanova, D., Kolovratova, V., Branka, M., Muraközy, G., Hielle-Wittmann, E., Aigner, C., Hoetzenecker, K., Wekerle, T., Worel, N., Knobler, R., & Jaksch, P. (2024). Extracorporeal Photopheresis for the prevention of rejection after lung transplantation – a prospective randomized controlled trial. European Respiratory Journal, 2400733. https://doi.org/10.1183/13993003.00733-2024
