title: Adjuvant treatment of refractory lung transplant rejection with extracorporeal photopheresis.
abstract: BACKGROUND
  Extracorporeal photopheresis is an immunomodulatory technique in which a patient's leukocytes are exposed to ultraviolet-A light after pretreatment with 8-methoxypsoralen (methoxsalen). There have been few reports describing the use of extracorporeal photopheresis in lung transplant recipients.
  
  
  METHODS
  We reviewed our experience using extracorporeal photopheresis in 8 lung transplant recipients since 1992. All 8 patients had progressively decreasing graft function and 7 were in bronchiolitis obliterans syndrome grade 3 before the initiation of photopheresis. One patient had undergone a second transplant operation for obliterative bronchiolitis. Two patients had a pretransplantation diagnosis of chronic obstructive pulmonary disease, 1 alpha1-antitrypsin deficiency, 1 cystic fibrosis, 1 bronchiectasis, 1 idiopathic pulmonary fibrosis, and 2 primary pulmonary hypertension. Before refractory rejection developed, all patients had been treated with 3-drug immunosuppression and anti-T-cell therapy. The median time from transplantation to the start of extracorporeal photopheresis was 16.5 months and the median number of treatments was 6.
  
  
  RESULTS
  The condition of 5 of 8 patients subjectively improved after extracorporeal photopheresis therapy. In these 5 patients photopheresis was associated with stabilization of the forced expiratory volume in 1 second. In 2 patients there was histologic reversal of rejection after photopheresis. With a median follow-up of 36 months, 7 patients are alive and well. Three patients required retransplantation at a median of 21 months after completion of the treatments. Four patients have remained in stable condition after photopheresis. There were no complications related to extracorporeal photopheresis.
  
  
  CONCLUSIONS
  We believe that this treatment is a safe option for patients with refractory lung allograft rejection when increased immunosuppression is contraindicated or ineffective.
authors.affiliation: University of Minnesota Departments of Surgery and Medicine, Division of Cardiovascular Surgery, Minneapolis, MN, USA.
authors.forename: C T
authors.initials: CT
authors.lastname: Salerno
authors.forename: S J
authors.initials: SJ
authors.lastname: Park
authors.forename: N S
authors.initials: NS
authors.lastname: Kreykes
authors.forename: D M
authors.initials: DM
authors.lastname: Kulick
authors.forename: K
authors.initials: K
authors.lastname: Savik
authors.forename: M I
authors.initials: MI
authors.lastname: Hertz
authors.forename: R M
authors.initials: RM
authors.lastname: Bolman
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D005541:Forced Expiratory Volume; D006084:Graft Rejection / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008168:Lung / Q000473:pathology; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D017893:Photopheresis; D012086:Reoperation
chemical_list: D007166:Immunosuppressive Agents