Photopheresis versus corticosteroids in the therapy of heart transplant rejection. Preliminary clinical report

Photopheresis is a technique in which reinfusion of mononuclear cells exposed to UV-A light ex vivo after in vivo treatment with 8-methoxypsoralen initiates host-immunosuppressive responses. To determine if photopheresis safely reverses International Society for Heart and Lung Transplantation (ISHLT...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 1992-11, Vol.86 (5 Suppl), p.II242
Main Authors: Costanzo-Nordin, M R, Hubbell, E A, O'Sullivan, E J, Johnson, M R, Mullen, G M, Heroux, A L, Kao, W G, McManus, B M, Pifarre, R, Robinson, J A
Format: Article
Language:English
Subjects:
Adult
Endocardium - pathology
Female
Graft Rejection - drug therapy
Heart Transplantation - immunology
Heart Transplantation - pathology
Humans
Leukapheresis
Male
Methoxsalen - therapeutic use
Methylprednisolone - therapeutic use
Myocardium - pathology
Photochemotherapy - methods
Prednisone - therapeutic use
Time Factors
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Summary:Photopheresis is a technique in which reinfusion of mononuclear cells exposed to UV-A light ex vivo after in vivo treatment with 8-methoxypsoralen initiates host-immunosuppressive responses. To determine if photopheresis safely reverses International Society for Heart and Lung Transplantation (ISHLT) rejection grades 2, 3A, and 3B without hemodynamic compromise, 16 heart transplant patients with ISHLT rejection grades 2, 3A, and 3B were randomized to photopheresis or corticosteroid therapy. The average number of mononuclear cells treated with each photopheresis procedure was 9.8 +/- 9.1 x 10(9) (mean +/- SD). Photopheresis and corticosteroids reversed eight of nine and seven of seven episodes of rejection, respectively. The median time from initiation of treatment to rejection reversal was 25 days (range, 6-67 days) in the photopheresis group and 17 days (range, 8-33 days) in the corticosteroid group. Hemodynamics were normal before either treatment and did not change after reversal of rejection. No adverse reactions occurred with photopheresis, and all patients in either treatment group are alive. These preliminary, short-term results in prospectively randomized patients indicate that photopheresis may be as effective as corticosteroids for treating ISHLT rejection grades 2, 3A, and 3B. The apparently low toxicity and potential efficacy of photopheresis warrant further analysis of its role in the prevention and treatment of heart transplant rejection.
ISSN:0009-7322