title: Photopheresis versus corticosteroids in the therapy of heart transplant rejection. Preliminary clinical report.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Loyola University of Chicago, Maywood.
authors.forename: M R
authors.initials: MR
authors.lastname: Costanzo-Nordin
authors.forename: E A
authors.initials: EA
authors.lastname: Hubbell
authors.forename: E J
authors.initials: EJ
authors.lastname: O'Sullivan
authors.forename: M R
authors.initials: MR
authors.lastname: Johnson
authors.forename: G M
authors.initials: GM
authors.lastname: Mullen
authors.forename: A L
authors.initials: AL
authors.lastname: Heroux
authors.forename: W G
authors.initials: WG
authors.lastname: Kao
authors.forename: B M
authors.initials: BM
authors.lastname: McManus
authors.forename: R
authors.initials: R
authors.lastname: Pifarre
authors.forename: J A
authors.initials: JA
authors.lastname: Robinson
mesh_terms: D000328:Adult; D004699:Endocardium / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy*; D016027:Heart Transplantation / Q000276:immunology* / Q000473:pathology; D006801:Humans; D007937:Leukapheresis; D008297:Male; D008730:Methoxsalen / Q000627:therapeutic use; D008775:Methylprednisolone / Q000627:therapeutic use*; D009206:Myocardium / Q000473:pathology; D010778:Photochemotherapy / Q000379:methods*; D011241:Prednisone / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D008730:Methoxsalen; D011241:Prednisone; D008775:Methylprednisolone