title: The use of extracorporeal photopheresis for allograft rejection in liver transplant recipients.
abstract: BACKGROUND
  Originally introduced for cutaneous T-cell lymphomas and autoimmune diseases, extracorporeal photopheresis (ECP) has been proven effective to reverse allograft rejection. The aim of the present work was to show the results of a single-center experience with ECP for the treatment of biopsy-proven rejection in selected liver transplant (LT) recipients.
  
  
  METHODS
  A retrospective review of five LT patients (M:F=4:1; median age 51 years) undergoing ECP for biopsy-proven allograft rejection between January 1996 and December 2003. In this period 476 LT were performed on 441 patients.
  
  
  RESULTS
  The indications for LT were three cases of HCV-related cirrhosis, complicated by hepatocellular carcinoma in two; one HBV-HDV-alcoholic cirrhosis; and one fulminant HBV hepatitis. All patients received calcineurin-inhibitor (CNI)-based immunosuppression with induction using anti-IL2R monoclonal antibodies. Indications for ECP were: ductopenic rejection in one patient with HCV recurrence; steroid-resistant acute rejection in two; acute rejection in a major ABO-mismatched liver graft; and one acute rejection in a patient with a proven allergy to steroids. The median interval from LT to inception of ECP was 43 days. The median number of ECP sessions per patient was 20. During the course of ECP, two patients tested positive for CMV antigenemia, associated in one case with bacterial pneumonia. All patients tolerated ECP and there were no procedure-related complications. At a median follow-up of 7.9 months after start of ECP, neither rejection relapses nor HCV/HBV recurrences have been observed. Three patients are off ECP with complete reversal and low-dose immunosuppression. Two patients are still receiving ECP with full-dose immunosuppression: one has achieved normal liver function but ECP is indicated due to a major ABO-incompatible liver graft, while the other patient's liver functions have not yet returned to baseline values.
authors.affiliation: Liver Transplant Unit, University of Pisa, Pisa, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Urbani
authors.forename: A
authors.initials: A
authors.lastname: Mazzoni
authors.forename: G
authors.initials: G
authors.lastname: Catalano
authors.forename: P
authors.initials: P
authors.lastname: De Simone
authors.forename: R
authors.initials: R
authors.lastname: Vanacore
authors.forename: C
authors.initials: C
authors.lastname: Pardi
authors.forename: M
authors.initials: M
authors.lastname: Bortoli
authors.forename: G
authors.initials: G
authors.lastname: Biancofiore
authors.forename: D
authors.initials: D
authors.lastname: Campani
authors.forename: V
authors.initials: V
authors.lastname: Perrone
authors.forename: F
authors.initials: F
authors.lastname: Mosca
authors.forename: F
authors.initials: F
authors.lastname: Scatena
authors.forename: F
authors.initials: F
authors.lastname: Filipponi
mesh_terms: D000328:Adult; D005112:Extracorporeal Circulation; D005260:Female; D006084:Graft Rejection / Q000628:therapy*; D006526:Hepatitis C / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D017893:Photopheresis; D012189:Retrospective Studies; D014184:Transplantation, Homologous