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

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

JOURNAL=Transplant International

VOLUME=36

YEAR=2024

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.11551

DOI=10.3389/ti.2023.11551

ISSN=1432-2277

ABSTRACT=<p>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 (<italic>p</italic> = 0.001). In multivariable Cox regression, both stabilization (HR: 0.48, CI: 0.27–0.86, <italic>p</italic> = 0.013) and response (HR: 0.11, CI: 0.04–0.35, <italic>p</italic> &lt; 0.001) to ECP were associated with survival. Absolute FEV1 at baseline was also protective (HR: 0.09, CI: 0.01–0.94, <italic>p</italic> = 0.046). RAS phenotype was the only risk factor for mortality (HR: 2.11, 1.16–3.83, <italic>p</italic> = 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.</p>