BACKGROUND: Photopheresis is a form of maintenance therapy designed to treat heart transplant patients who have had refractory rejection, chronic left ventricular dysfunction, or chronically elevated circulating antibodies. Reports have demonstrated benefit in all of these categories with improvement in cardiac function and decrease in biopsy proven rejection. It has not been delineated whether an anti-inflammatory process is present.
METHODS: Between 2010 and 2011, we assessed 7 heart transplant patients who underwent photopheresis over a 6 month course in patients with chronic left ventricular dysfunction (n=6) and in 1 patient with recurrent antibody-mediated rejection (AMR) on heart biopsy. Patient heparinized plasma was assayed for inflammatory cytokines before and after photopheresis using luminex assays. Other end points included change in echocardiographic left ventricular dysfunction, follow up heart biopsy results, and decline in circulating antibodies.
RESULTS: Of the 6 patients with chronic left ventricular dysfunction, all patients improved cardiac function from a baseline echo of 38 ± 14% to 51 ± 8% (p = 0.048) at follow up after photopheresis. In the 1 patient who had recurrent AMR, no further AMR was observed in follow up biopsies. There was a significant decrease in mean peak PRA after photopheresis from baseline (83 ± 17% to 38 ± 42%, p = 0.022). Inflammatory cytokines including interleukin (IL)-6, IL- 10, IL-17A, TGF-Β1, IFNg, sE-Sel, Total-IgG all declined after photopheresis but only TGF-Β1 was significant (see table).
|Endpoints||Pre-photophoresis (N=7)||Post-Photophoresis (N=7)||p-value|
|Mean Peak PRA, %±SD||83±17||38±42||0.022|
|Mean IFNg, pg/mL±SD||3.8±6.7||1.1±1.5||0.319|
|Mean IL-10, pg/mL±SD||27.8±39.1||10.7±20.1||0.324|
|Mean IL-17A, pg/mL±SD||7.4±8.5||1.4±3.3||0.107|
|Mean IL-6, pg/mL±SD||3.8±4.2||1.6±1.8||0.227|
|Mean TGF-Β1, ng/mL±SD||7.3±2.8||3.2±2.1||0.009|
|Mean sE-Sel, ng/mL±SD||60.4±27.0||47.4±13.3||0.275|
|Mean Total-IgG, mg/mL±SD||7.7±5.1||4.7±2.5||0.188|
CONCLUSION: Photopheresis appears to be effective in reversing chronic left ventricular dysfunction due to rejection and appears to have an anti-inflammatory mechanism. A larger number of patients are needed to confirm these observations.
To cite this abstract in AMA style:Kobashigawa J, Watanabe J, Shafi H, Patel J, Kittleson M, Jordan S, Klapper E, Toyoda M. Clinical and Mechanistic Outcomes of Photopheresis after Heart Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/clinical-and-mechanistic-outcomes-of-photopheresis-after-heart-transplantation/. Accessed September 18, 2021.
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