Successful treatment of recurrent rejection in renal transplant patients with photopheresis

Roberto Dall'Amico, Luisa Murer, Giovanni Montini, Barbara Andreetta, Giovanni Franco Zanon, Graziella Zacchello, Franco Zacchello

Research output: Contribution to journalArticle

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Abstract

Photopheresis (ECP) is a new form of photochemotherapy that induces a selective inhibition of the host response to foreign histocompatibility antigens and reverses allograft rejection after organ transplantation. This report describes four adolescent patients with recurrent rejection episodes after renal transplantation, all uncontrolled using standard protocols of immunosuppression (intravenous steroids and OKT3), yet successfully treated with a 6-mo course of ECP. The ECP treatment was performed at weekly intervals during the first month, at 2-wk intervals during the second and third months, and then monthly for another 3 mo. Creatinine clearance improved throughout the treatment in three patients and remained unchanged in one. All patients had a pre-ECP biopsy with a grade 2 or 3 rejection (Banff) with a diffuse infiltrate CD8, CD14, LFA-1 (166 cells positive/0.048 mm2), and VLA-4 (51 cells positive/0.048 mm2) positive, as well as a tubular expression of HLA-DR (6.2 sections of tubule positive/0.048 mm2), ICAM-1, and VCAM-1 (3.1 and 2.9 sections of tubule positive/0.048 mm2). A strong reduction of cell infiltrate and expression of LFA-1 (6.6 cells positive/0.048 mm2), VLA-4 (0.7 cells positive/0.048 mm2), HLA-DR (0.2 section of tubules positive/0.048 mm2), ICAM-1 (0.3 section of tubules positive/0.048 mm2), and a disappearance of VCAM-1 staining were observed in the biopsies performed after 3 mo of ECP. All patients remained rejection- free during ECP, without infections or other complications commonly observed with increasing doses of standard immunosuppression. The clinical improvement allowed a progressive reduction of oral steroids in three of the four patients treated.

Original languageEnglish
Pages (from-to)121-127
Number of pages7
JournalJournal of the American Society of Nephrology
Volume9
Issue number1
Publication statusPublished - Jan 1998

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Photopheresis
Transplants
Kidney
Integrin alpha4beta1
Lymphocyte Function-Associated Antigen-1
Vascular Cell Adhesion Molecule-1
HLA-DR Antigens
Intercellular Adhesion Molecule-1
Immunosuppression
Steroids
Biopsy
Therapeutics
Muromonab-CD3
Histocompatibility Antigens
Photochemotherapy
Organ Transplantation
Kidney Transplantation
Allografts
Creatinine
Staining and Labeling

ASJC Scopus subject areas

  • Nephrology

Cite this

Dall'Amico, R., Murer, L., Montini, G., Andreetta, B., Zanon, G. F., Zacchello, G., & Zacchello, F. (1998). Successful treatment of recurrent rejection in renal transplant patients with photopheresis. Journal of the American Society of Nephrology, 9(1), 121-127.

Successful treatment of recurrent rejection in renal transplant patients with photopheresis. / Dall'Amico, Roberto; Murer, Luisa; Montini, Giovanni; Andreetta, Barbara; Zanon, Giovanni Franco; Zacchello, Graziella; Zacchello, Franco.

In: Journal of the American Society of Nephrology, Vol. 9, No. 1, 01.1998, p. 121-127.

Research output: Contribution to journalArticle

Dall'Amico, R, Murer, L, Montini, G, Andreetta, B, Zanon, GF, Zacchello, G & Zacchello, F 1998, 'Successful treatment of recurrent rejection in renal transplant patients with photopheresis', Journal of the American Society of Nephrology, vol. 9, no. 1, pp. 121-127.
Dall'Amico, Roberto ; Murer, Luisa ; Montini, Giovanni ; Andreetta, Barbara ; Zanon, Giovanni Franco ; Zacchello, Graziella ; Zacchello, Franco. / Successful treatment of recurrent rejection in renal transplant patients with photopheresis. In: Journal of the American Society of Nephrology. 1998 ; Vol. 9, No. 1. pp. 121-127.
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