A European Multi-Center Analysis of Extracorporeal Photopheresis as Therapy for Chronic Lung Allograft Dysfunction

Alberto Benazzo; Cecilia Bagnera; Fabio Ius; Claudia Del Fante; Jens Gottlieb; Konrad Hoetzenecker; Federica Meloni; Peter Jaksch; Mark Greer

doi:10.3389/ti.2023.11551

A European Multi-Center Analysis of Extracorporeal Photopheresis as Therapy for Chronic Lung Allograft Dysfunction

Transpl Int. 2024 Jan 12:36:11551. doi: 10.3389/ti.2023.11551. eCollection 2023.

Authors

Alberto Benazzo¹, Cecilia Bagnera², Fabio Ius^{3

4}, Claudia Del Fante⁵, Jens Gottlieb^{3

6}, Konrad Hoetzenecker¹, Federica Meloni², Peter Jaksch¹, Mark Greer^{3

6}

Affiliations

¹ Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
² Malattie dell'Apparato Respiratorio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
³ Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
⁴ Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
⁵ Servizio Immunoematologia e Medicina Trasfusionale, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
⁶ German Centre for Lung Research, Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, Hannover, Germany.

Abstract

Extracorporeal photopheresis (ECP) is used by few lung transplant centers to treat chronic lung allograft dysfunction (CLAD). Although reported results suggest a beneficial effect on CLAD progression, evidence is limited to single center experiences. The aim of this study is to analyze outcomes of ECP in a large multicenter European cohort. The primary endpoint was patient survival after initiation of ECP. This study included 631 patients, 87% suffered from bronchiolitis obliterans syndrome (BOS), and 13% had restrictive allograft syndrome (RAS). Long-term stabilization was achieved in 42%, improvement in 9%, and no response in 26%. Within the first 12 months of therapy, 23% of patients died. Patients' survival after initiation of ECP at 5 years was 56% in stable, 70% in responders, and 35% in non-responders (p = 0.001). In multivariable Cox regression, both stabilization (HR: 0.48, CI: 0.27-0.86, p = 0.013) and response (HR: 0.11, CI: 0.04-0.35, p < 0.001) to ECP were associated with survival. Absolute FEV1 at baseline was also protective (HR: 0.09, CI: 0.01-0.94, p = 0.046). RAS phenotype was the only risk factor for mortality (HR: 2.11, 1.16-3.83, p = 0.006). This study provides long-term outcomes of ECP use in CLAD patients in the largest published cohort to date. Two-thirds of the cohort had a sustained response to ECP with excellent long-term results.

Keywords: CLAD; FEV1; extracorporeal photopheresis; lung function; lung transplantation.

Publication types

Multicenter Study

MeSH terms

Allografts* / physiopathology
Cohort Studies
Humans
Lung Transplantation* / methods
Photopheresis* / methods

Grants and funding

The authors declare that this study received funding from Mallinckrodt Pharmaceuticals. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.