Extracorporeal photopheresis in heart transplant rejection.
Up to 25% of heart transplant recipients develop rejection requiring intervention. While the majority respond to augmentation of immunomodulatory drug therapy, a subset of patients will remain refractory. Extracorporeal photopheresis (ECP) appears particularly useful in the management of select heart transplant recipients at risk of rejection, with recurrent rejection, or rejection associated with hemodynamic compromise. This chapter summarizes the current clinical experience of ECP in heart transplantation. ECP appears to favorably affect both the cellular and humoral arms of the immune response to the allograft and promote a tolerogenic profile. These immunomodulatory effects also appear to decrease development of cardiac allograft vasculopathy. ECP is generally well tolerated with few adverse effects and low infection risk.
Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Third Floor Cardiology A3107, Los Angeles, CA 90048, United States.
Jignesh
J
Patel
Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Third Floor Cardiology A3107, Los Angeles, CA 90048, United States.
Ellen
E
Klapper
Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Third Floor Cardiology A3107, Los Angeles, CA 90048, United States.
Hedyeh
H
Shafi
Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Third Floor Cardiology A3107, Los Angeles, CA 90048, United States. Electronic address: kobashigawaj@cshs.org.
Jon A
JA
Kobashigawa
D064591:Allografts; D016207:Cytokines / Q000378:metabolism; D006084:Graft Rejection / Q000276:immunology* / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007107:Immune System; D007111:Immunity, Cellular; D056724:Immunity, Humoral; D007155:Immunologic Factors / Q000627:therapeutic use; D056747:Immunomodulation; D017893:Photopheresis / Q000379:methods*
D016207:Cytokines; D007155:Immunologic Factors