背景:在标准免疫抑制疗法中加入体外光化学疗法(ECP)被认为对治疗复发性/持续性心脏排斥反应有益。
方法:我们回顾了2010年至2016年在我们机构接受ECP的心脏移植受者的医疗数据。
结果:在研究期间,8例患者接受了9个ECP疗程.从移植到ECP的中位时间为18个月(范围9-54)。ECP的适应症是6例患者的复发性排斥反应,1例患者持续排斥反应和1例患者血液动力学受损的混合排斥反应。患者选择的其他标准以限制免疫抑制疗法增加的相关合并症为代表。8名患者中有6名在门诊进行了ECP。中位ECP持续时间为12个月(范围1-18)。8例患者中有3例对ECP有反应,在治疗结束时显示心内膜活检阴性。在他们的随访中(在44、72和31个月)没有观察到额外的排斥事件。8名患者中有4名对ECP治疗无效,一名患者被判定为不可评估。在所有3名反应敏感的患者中,以及在3名具有稳定程度的排斥反应的患者中,都获得了免疫抑制疗法的减少。中位随访时间为26个月(6-80个月)。两名患者在开始ECP后6个月和21个月死亡。ECP后26个月生存率为78.2%。未报告与ECP相关的不良反应或感染性并发症。
结论:我们病例系列中的低反应率(37.5%)可以部分解释为患者选择,接受治疗的患者代表高危亚组。需要进一步研究以提供ECP在心脏排斥治疗或预防中的作用的证据。
BACKGROUND: The addition of extracorporeal photochemotherapy (ECP) to standard immunosuppressive therapy has been suggested to be beneficial in the treatment of recurrent/persistent heart rejection.
METHODS: We reviewed medical data of heart transplant recipients who received ECP between 2010 and 2016 at our institution.
RESULTS: During the study period, eight patients underwent nine ECP courses. The median time from transplant to ECP was 18 months (range 9-54). Indications for ECP were recurrent rejection in 6 patients, persistent rejection in 1 patient and mixed rejection with hemodynamic compromise in 1 patient. Additional criteria for patients\' selection were represented by relevant comorbidities limiting the increase of immunosuppressive therapies. ECP was performed on an outpatient basis in 6 out of 8 patients. The median ECP duration was 12 months (range 1-18). Three out of 8 patients responded to ECP showing negative endomyocardial biopsies at the end of treatment. No additional rejection episodes were observed at their follow up (at 44, 72 and 31 months). Four of 8 patients failed to respond to ECP treatment, one patient has been judged not evaluable. Reduction of immunosuppressive therapies was obtained in all 3 responsive patients but also in 3 patients with a stable grade of rejection. The median duration of the follow up was 26 months (range 6-80). Two patients died at 6 and 21 months after beginning ECP. Survival after ECP was 78.2% at 26 months. No adverse effect or infectious complications associated with ECP were reported.
CONCLUSIONS: The low response rate (37.5%) in our case series could be partially explained by patient selection, the treated patients representing a high-risk sub-set group. Further studies to provide evidence of a role for ECP in heart rejection treatment or prophylaxis are needed.