Extracorporeal photochemotherapy as adjuvant treatment of heart transplant recipients with recurrent rejection

Roberto Dall’Amicό, Ugo Livi, Aldo Milano, Giovanni Montini, Barbara Andreetta, Luisa Murer, Graziella Zacchello, Gaetano Thiene, Dino Casarotto, Franco Zacchello

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Abstract

Recurrent rejection is an uncommon, severe complication after heart transplantation that is associated with a poor long-term prognosis. Photopheresis (ECP), a new form of extracorporeal photo-chemotherapy used for the treatment of cutaneous T cell lymphoma and several autoimmune diseases, has also been used for prevention and treatment of acute rejection in heart transplant recipients. It seems to induce specific suppression of both cellular and humoral rejection. In this study, we evaluated whether ECP added to standard therapies allowed better control of rejection and reduction of conventional immunosuppressive drugs in patients with repeated rejection episodes. Eight heart transplant recipients (β men and 2 women, mean age 48 yr), with recurrent rejection were treated with ECP for 6 months. Endomyocardial biopsies (EMB) were performed monthly. As a result of treatment, 7 patients on ECP experienced a reduction of the number and severity of rejection episodes. The fraction of EMB negative for rejection increased from 13 to 41%, whereas the fraction of specimens with multifocal and/or diffuse moderate lymphocytes infiltration (grades ЗА and 3B) decreased from 41 to 21%. ECP allowed reductions of daily immunosuppressive therapy: prednisone by 44% (16.9 vs. 9.4 mg), cyclosporine by 21% (366 vs. 291 mg), and azathioprine by 29% (137 vs. 07 mg). No major side effects were observed. We conclude that, although the number of patients is small, the use of ECP was safe and associated with improved control of recurrent rejection. This allowed tapering of immunosuppressive drugs, which was particularly useful in two patients with insulin-depen dent diabetes and one with sternal wound osteomyelitis.

Original languageEnglish
Pages (from-to)45-49
Number of pages5
JournalTransplantation
Volume60
Issue number1
Publication statusPublished - Jul 15 1995

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Photopheresis
Immunosuppressive Agents
Biopsy
Therapeutics
Cutaneous T-Cell Lymphoma
Azathioprine
Osteomyelitis
Heart Transplantation
Prednisone
Pharmaceutical Preparations
Cyclosporine
Autoimmune Diseases
Transplant Recipients
Lymphocytes
Insulin
Drug Therapy
Wounds and Injuries

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Dall’Amicό, R., Livi, U., Milano, A., Montini, G., Andreetta, B., Murer, L., ... Zacchello, F. (1995). Extracorporeal photochemotherapy as adjuvant treatment of heart transplant recipients with recurrent rejection. Transplantation, 60(1), 45-49.

Extracorporeal photochemotherapy as adjuvant treatment of heart transplant recipients with recurrent rejection. / Dall’Amicό, Roberto; Livi, Ugo; Milano, Aldo; Montini, Giovanni; Andreetta, Barbara; Murer, Luisa; Zacchello, Graziella; Thiene, Gaetano; Casarotto, Dino; Zacchello, Franco.

In: Transplantation, Vol. 60, No. 1, 15.07.1995, p. 45-49.

Research output: Contribution to journalArticle

Dall’Amicό, R, Livi, U, Milano, A, Montini, G, Andreetta, B, Murer, L, Zacchello, G, Thiene, G, Casarotto, D & Zacchello, F 1995, 'Extracorporeal photochemotherapy as adjuvant treatment of heart transplant recipients with recurrent rejection', Transplantation, vol. 60, no. 1, pp. 45-49.
Dall’Amicό R, Livi U, Milano A, Montini G, Andreetta B, Murer L et al. Extracorporeal photochemotherapy as adjuvant treatment of heart transplant recipients with recurrent rejection. Transplantation. 1995 Jul 15;60(1):45-49.
Dall’Amicό, Roberto ; Livi, Ugo ; Milano, Aldo ; Montini, Giovanni ; Andreetta, Barbara ; Murer, Luisa ; Zacchello, Graziella ; Thiene, Gaetano ; Casarotto, Dino ; Zacchello, Franco. / Extracorporeal photochemotherapy as adjuvant treatment of heart transplant recipients with recurrent rejection. In: Transplantation. 1995 ; Vol. 60, No. 1. pp. 45-49.
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