Rejection With Hemodynamic Compromise: Objective Evidence for Efficacy of Photopheresis

Kirklin, J.K.; Brown, R.N.; Huang, S.T.; Naftel, D.C.; Hubbard, S.M.; Rayburn, B.K.; McGiffin, D.C.; Bourge, R.B.; Benza, R.L.; Tallaj, J.A.; Pinderski, L.J.; Pamboukian, S.V.; George, J.F.; Marques, M.

doi:10.1016/j.healun.2005.10.004

« Previous Next »The Journal of Heart and Lung Transplantation
Volume 25, Issue 3 , Pages 283-288, March 2006

Rejection With Hemodynamic Compromise: Objective Evidence for Efficacy of Photopheresis

J.K. Kirklin, MD
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
- Reprint requests: J. K. Kirklin, MD, Department of Surgery, University of Alabama at Birmingham, 739 Zeigler Building, Birmingham, AL 35294. Telephone: 205-934-3368. Fax: 205-934-5261
R.N. Brown, BS
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
S.T. Huang, MD
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
D.C. Naftel, PhD
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
S.M. Hubbard, MD
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
B.K. Rayburn, RN
- Department of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
D.C. McGiffin, MD
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
R.B. Bourge, MD
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
R.L. Benza, MD
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
J.A. Tallaj, MD
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
L.J. Pinderski, MD, PhD
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
S.V. Pamboukian, MD
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
J.F. George, PhD
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
M. Marques, MD
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama

Received 28 April 2005; received in revised form 21 September 2005; accepted 5 October 2005. published online 30 January 2006.

Background

Photopheresis therapy (photo) has been advocated as a therapy to improve outcome after recalcitrant or severe rejection, but objective evidence of a beneficial effect has been elusive. This study examined the hypothesis that photo provides protection against rejection, rejection with hemodynamic compromise (HC), and death from rejection after cardiac transplantation.

Methods

Between 1990 and 2003, 36 adult patients (from 343 adult transplant recipients) received at least 3 months of photo (2-day treatment every 3 to 6 weeks for a target of 18 months) after HC rejection (n = 12), recurrent/recalcitrant rejection (n = 20), or as prophylaxis in the presence of anti-donor antibodies (n = 4). Survival and risk factors were examined by analysis using multivariate hazard function modulated renewal function.

Results

Patients selected for photo were at greater risk for rejection (p < 0.0001) and HC rejection (p < 0.0001) than non-photo patients. After 3 months of photo therapy, rejection risk was decreased (p = 0.04). More importantly, the hazard for subsequent HC rejection or rejection death was significantly reduced toward the risk-adjusted level of lower-risk non-photo patients (p = 0.006).

Conclusions

This study provides objective evidence that photo reduces the risk of subsequent HC rejection and/or death from rejection when initiated for patients with high rejection risk. Photopheresis is recommended as an important therapeutic modality after rejection with hemodynamic compromise, although further studies are needed to define the precise mechanism of the effect and the potential for benefit in other patient sub-sets.