Elsevier

Transplantation Proceedings

Volume 43, Issue 8, October 2011, Pages 2938-2940
Transplantation Proceedings

Renal transplantation
Immunosuppresive therapy
Extracorporeal Photopheresis as an Antirejection Prophylaxis in Kidney Transplant Recipients: Preliminary Results

https://doi.org/10.1016/j.transproceed.2011.08.061Get rights and content

Abstract

Extracorporeal photopheresis (ECP) is considered a promising immunomodulatory therapy of acute allograft rejection in organ transplantation and graft-versus-host disease. Our aim was to investigate the biological responses of 10 patients who underwent kidney transplantation with ECP as prophylactic treatment. They received conventional immunosuppressive therapy plus ECP immediately after transplantation: 12 to 16 applications over the course of 2.5 months. ECP procedures were performed using an automated system for leukocyte separation and photoactivation with methoxsalen. All recipients were followed by estimated glomerular filtration rate (eGFR) and peripheral T, B, natural killer, T-regulatory (Treg) and dendritic cells (DC) counts and phenotypes. An acute rejection episode appeared in one control group recipient. The ECP group showed a positive trend to an higher GFR at months 3 (53 ± 11 vs 47.1 ± 9; P = .17) and 6 (67.5 ± 10 vs 53.6 ± 3; P = .03, Wilcoxon test). An increased percentage of Treg (CD3+ CD4+ CD25+) among the total CD3 cell count (4.9% ± 1% to 9.4% ± 15%) as well as inducible Treg (CD3+ CD8+ CD28) was observed among CD3 cells (3.3% ± 3% to 11.8% ± 8%, P = .025) within 3 months of ECP treatment. A significant difference in the percentage of Treg was noted at month 3 (completed ECP) between the ECP and the control groups (9.4% ± 15% vs 3% ± 1%; P = .01). Addition of ECP to standard immunosuppression was associated with a significantly higher GFR at 6 months and with a significant increase in natural Treg among CD3 cells.

Section snippets

Selection and Description of Participants

Twenty consecutive kidney allograft recipients who received kidneys from 10 cadaveric donors (10 pairs) were assigned to the ECP-treated or the control group. Selection was based on ECP exclusion criteria and declared patient adherence to study visits over at least 12 months post-KTx. If both initial criteria were met, we performed a randomization. The ECP group underwent 12 to 16 ECP procedures in the first 3 months following KTx. Control and ECP subjects were prescribed mycophenolate mofetil

Results

Biopsy-proven acute rejection appeared in one control group recipient. The ECP group showed a positive tendency to a higher eGFR at months 3 (53 ± 11 vs 47.1 ± 9 mL/min/1.73 m2; P = .17) and a significant difference at 6 months (67.5 ± 10 vs 53.6 ± 3 mL/min/1.73 m2; P = .03 in Wilcoxon test; (Table 1).

Increased percentages of Treg (CD3+ CD4+ CD25+) in the total CD3 cell count (4.9% ± 1% to 9.4% ± 15%) as well as among inducible Treg (CD3+ CD8+ CD28) among CD3 cells (3.3% ± 3% to 11.8% ± 8%; P

Discussion

Currently available immunosuppressive drugs are associated with severe complications such as hypertension, diabetes mellitus, infectious risk, and malignancies. Often they do not present episodes of rejection. New, less-toxic immunologic measures are needed to reduce the side effects. ECP has been shown to benefit patients with cardiac,3 but also kidney transplantations. A few reports have suggested that ECP serves as an effective “rescue” therapy for kidney rejection episodes resistant to

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This work was supported by the Ministry of Science and Higher Education (MNiSW, Poland, Grant No. N402 178934).

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