The efficacy of photopheresis for bronchiolitis obliterans syndrome after lung transplantation
published online 26 October 2009.
Background
Extracorporeal photopheresis (ECP) has been used to treat acute and chronic rejection after solid organ transplantation. However, data supporting the use of ECP for bronchiolitis obliterans syndrome (BOS) after lung transplantation are limited.
Methods
We retrospectively analyzed the efficacy and safety of ECP for progressive BOS at our institution. Between January 1, 2000, and December 31, 2007, 60 lung allograft recipients were treated with ECP for progressive BOS.
Results
During the 6-month period before the initiation of ECP, the average rate of decline in forced expiratory volume in 1 second (FEV1) was −116.0 ml/month, but the slope decreased to −28.9 ml/month during the 6-month period after the initiation of ECP, and the mean difference in the rate of decline was 87.1 ml/month (95% confidence interval, 57.3–116.9; p < 0.0001). The FEV1 improved in 25.0% of patients after the initiation of ECP, with a mean increase of 20.1 ml/month.
Conclusions
ECP is associated with a reduction in the rate of decline in lung function associated with progressive BOS.
aDivision of Pulmonary & Critical Care Medicine, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
bDepartment of Pathology, Immunology and Anesthesiology, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
cDepartment of Pathology and Immunology, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
dDivision of Cardiothoracic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
Reprint requests: Matthew R. Morrell, MD, Division of Pulmonary & Critical Care Medicine, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8052, St. Louis, MO 63110. Telephone: 314-454-8766. Fax: 314-454-7956
ABSTRACT