Potential Applications of Extracorporeal Photopheresis in Liver Transplantation

Abstract Extracorporeal photopheresis (ECP) is an immunomodulatory therapy performed through a temporary peripheral venous access with documented efficacy in heart and renal transplantation. We originally reported that ECP represented a valuable alternative to treat graft rejection in selected liver...

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Bibliographic Details
Published in:	Transplantation proceedings 2008-05, Vol.40 (4), p.1175-1178
Main Authors:	Urbani, L, Mazzoni, A, Colombatto, P, Biancofiore, G, Bindi, L, Tascini, C, Menichetti, F, Brunetto, M, Scatena, F, Filipponi, F
Format:	Article
Language:	eng
Subjects:	Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Calcineurin Inhibitors Emergency and intensive care: digestive diseases. Bioartificial liver Fundamental and applied biological sciences. Psychology Fundamental immunology Graft Rejection - prevention & control Humans Immunotherapy - methods Intensive care medicine Liver Transplantation - immunology Liver, biliary tract, pancreas, portal circulation, spleen Medical sciences Photopheresis - methods Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Tissue, organ and graft immunology Treatment Outcome
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Summary:	Abstract Extracorporeal photopheresis (ECP) is an immunomodulatory therapy performed through a temporary peripheral venous access with documented efficacy in heart and renal transplantation. We originally reported that ECP represented a valuable alternative to treat graft rejection in selected liver transplant (OLT) recipients. We have investigated potential applications of ECP for prophylaxis of allograft rejection. The first field explored was the use of ECP for delayed introduction of calcineurin inhibitors (CNI) among high-risk OLT recipients seeking to avoid CNI toxicity. In 42 consecutive patients that we assigned to prophylaxis with ECP, we were able to delay CNI introduction after postoperative day 8 in one-third of them. The second field was the use of ECP for prophylaxis of acute cellular rejection among ABO-incompatible OLT recipients. In our experience, none of 11 patients treated with ECP developed a cell-mediated rejection. The third field was ECP application in hepatitis C virus-positive patients seeking to reduce the immunosuppressive burden and improve sustainability and efficacy of preemptive antiviral treatment with interferon and ribavirin. Among 78 consecutive patients, we were able to start preemptive antiviral treatment in 69.2% of them at a median time from OLT of 14 days (range = 7 to 130 days). Thirty-six (66.7%) patients completed the treatment course with an end of treatment virological response of 50.0% and a sustained virological response of 38.9%. These preliminary results await validation in larger prospective studies with longer follow-up periods.
ISSN:	0041-1345 1873-2623