Introduction: Survival following lung transplantation (LTx) is limited by the development of Chronic Lung Allograft Dysfunction (CLAD), for which there are few effective therapies and no standardized management. Several small studies have demonstrated effectiveness of extracorporeal photopheresis (ECP) as a therapeutic option for CLAD.
Methods: A retrospective audit of 12 LTx recipients who received ECP for CLAD over 5 years (2013 - 2018) at the Alfred Hospital, Melbourne was completed. Non-Responders to ECP were defined as patients who experienced a 20% decrease in Forced Expiratory Volume1 (FEV1) within 6 weeks of commencing therapy.
Results: Mean time since LTx was 849 days and mean time since diagnosis of CLAD was 131 days. 58% were male (n=7). 67% (n=8) responded to ECP therapy, as deemed by stabilization of their lung function. Amongst responders, the rate of decline in FEV1 pre ECP was 9.0mls/day, compared to 1.4mls/day post ECP (p=0.01). Amongst non-responders, rate of FEV1 decline was 7.2mls/day pre ECP and 5.0mls/day post ECP. Non-responders were more likely to be female (p = 0.01) and leukopenic (p = 0.02). Patients with prior exposure to Anti-thymocyte globulin (ATG) had a lowered response to ECP.
Discussion: Our cohort provides unique perspective into the outcomes for use of ECP as rescue therapy for CLAD. Outcomes are similar to other single centre experiences
Conclusion: ECP arrested the decline of lung function in 67% of patients with CLAD. Gender, pre ECP white cell count and exposure to ATG may help determine response to ECP, which has not previously been described. Future clinical trials are needed to confirm this effect, help predict response to therapy and ultimately guide the placement of ECP in the treatment algorithm for CLAD.