Extracorporeal Photopheresis With Low-Dose Immunosuppression in High-Risk Heart Transplant Patients-A Pilot Study.
CNI delay
extracorporeal photopheresis
heart transplantation
immunosuppression
induction therapy
Journal
Transplant international : official journal of the European Society for Organ Transplantation
ISSN: 1432-2277
Titre abrégé: Transpl Int
Pays: Switzerland
ID NLM: 8908516
Informations de publication
Date de publication:
2022
2022
Historique:
received:
22
12
2021
accepted:
11
02
2022
entrez:
11
4
2022
pubmed:
12
4
2022
medline:
13
4
2022
Statut:
epublish
Résumé
In severely ill patients undergoing urgent heart transplant (HTX), immunosuppression carries high risks of infection, malignancy, and death. Low-dose immunosuppressive protocols have higher rejection rates. We combined extracorporeal photopheresis (ECP), an established therapy for acute rejection, with reduced-intensity immunosuppression. Twenty-eight high-risk patients (13 with high risk of infection due to infection at the time of transplant, 7 bridging to transplant via extracorporeal membrane oxygenation, 8 with high risk of malignancy) were treated, without induction therapy. Prophylactic ECP for 6 months (24 procedures) was initiated immediately postoperatively. Immunosuppression consisted of low-dose tacrolimus (8-10 ng/ml, months 1-6; 5-8 ng/ml, >6 months) with delayed start; mycophenolate mofetil (MMF); and low maintenance steroid with delayed start (POD 7) and tapering in the first year. One-year survival was 88.5%. Three patients died from infection (POD 12, 51, 351), and one from recurrence of cancer (POD 400). Incidence of severe infection was 17.9% (
Identifiants
pubmed: 35401042
doi: 10.3389/ti.2022.10320
pii: 10320
pmc: PMC8983826
doi:
Substances chimiques
Immunosuppressive Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
10320Informations de copyright
Copyright © 2022 Gökler, Aliabadi-Zuckermann, Zuckermann, Osorio, Knobler, Moayedifar, Angleitner, Leitner, Laufer and Worel.
Déclaration de conflit d'intérêts
JG, AZ, RK, and NW have been part of Mallinckrodt’s Speaker bureau. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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