Extracorporeal photopheresis for the treatment of graft rejection in 33 adult kidney transplant recipients. (August 2019)

• Record Type: Journal Article
• Authors: Tamain, Mathilde; Sayegh, Johnny; Lionet, Arnaud; Grimbert, Philippe; Philipponnet, Carole; Hazzan, Marc; Augusto, Jean-François; Büchler, Mathias; Merlin, Etienne; Kosmadakis, George; Tiple, Aurélien; Pereira, Bruno; Garrouste, Cyril; Heng, Anne-Elisabeth
• Is Part Of: Transfusion and apheresis science. Volume 58:Number 4(2019)
• Page Start: 515
• Page End: 524
• Publication Date: 2019-08
• Subjects: 8-MOP methoxypsoralen -- AAMR acute antibody-mediated rejection -- ACR acute cellular rejection -- AMR antibody-mediated rejection -- Anti-HLA Abs anti-human leukocyte antigen antibodies -- ASFA American Society for Apheresis -- ATG anti-thymocyte globulin -- CAMR chronic antibody-mediated rejection -- CNIs calcineurin inhibitors -- CMV cytomegalovirus -- CTCL cutaneous T cell lymphoma -- DSAs donor-specific antibodies -- EBV Epstein-Barr virus -- ECP extracorporeal photopheresis -- ESKD end-stage kidney disease -- FMDA factorial mixed data analysis -- GFR glomerular filtration rate -- HAS Haute Autorité de Santé -- IL1β interleukin-1β -- KT kidney transplantation -- MFI mean-fluorescence intensity -- MMF mycophenolate mofetil -- MP methylprednisolone pulses -- NK natural killer lymphocyte -- PBMCs peripheral blood mononuclear cells; Kidney transplantation -- Allograft rejection -- Extracorporeal photopheresis; Blood -- Transfusion -- Periodicals; Hemapheresis -- Periodicals; 615.39
• DOI: 10.1016/j.transci.2019.06.031
• Languages: English
• ISSNs: 1473-0502

Abstract

Abstract: Background - Extracorporeal photopheresis (ECP) has shown encouraging results in the prevention of allograft rejection in heart transplantation. However, the role of ECP in kidney transplant (KT) rejection needs to be determined. Methods - This multicentre retrospective study included 33 KT recipients who were treated with ECP for allograft rejection (23 acute antibody-mediated rejections (AMRs), 2 chronic AMRs and 8 acute cellular rejections (ACRs)). The ECP indications were KT rejection in patients who were resistant to standard therapies (n = 18) or in patients for whom standard therapies were contraindicated because of concomitant infections or cancers (n = 15). Results - At 12 months (M12) post-ECP, 11 patients (33%) had a stabilization of kidney function with a graft survival rate of 61%. The Banff AMR score (g + ptc + v) was a risk factor for graft loss at M12 (HR 1.44 [1.01–2.05], p < 0.05). The factorial mixed data analysis identified 2 clusters. Patients with a functional graft at M12 tended to have cellular and/or chronic rejections. Patients with graft loss at M12 tended to have acute rejections and/or AMR; higher serum creatinine levels; DSA levels and histologic scores of AMR; and a longer delay between the rejection and ECP start than those of patients with functional grafts. Conclusions - ECP may be helpful to control ACR or moderate AMR in KT recipients presenting concomitant opportunistic infections or malignancies when it is initiated early.