TY - JOUR AU - Gökler, Johannes AU - Aliabadi-Zuckermann, Arezu AU - Zuckermann, Andreas AU - Osorio, Emilio AU - Knobler, Robert AU - Moayedifar, Roxana AU - Angleitner, Philipp AU - Leitner, Gerda AU - Laufer, Günther AU - Worel, Nina PY - 2022 M3 - Original Research TI - Extracorporeal Photopheresis With Low-Dose Immunosuppression in High-Risk Heart Transplant Patients—A Pilot Study JO - Transplant International UR - https://www.frontierspartnerships.org/articles/10.3389/ti.2022.10320 VL - 35 SN - 1432-2277 N2 - In severely ill patients undergoing urgent heart transplant (HTX), immunosuppression carries high risks of infection, malignancy, and death. Low-dose immunosuppressive protocols have higher rejection rates. We combined extracorporeal photopheresis (ECP), an established therapy for acute rejection, with reduced-intensity immunosuppression. Twenty-eight high-risk patients (13 with high risk of infection due to infection at the time of transplant, 7 bridging to transplant via extracorporeal membrane oxygenation, 8 with high risk of malignancy) were treated, without induction therapy. Prophylactic ECP for 6 months (24 procedures) was initiated immediately postoperatively. Immunosuppression consisted of low-dose tacrolimus (8–10 ng/ml, months 1–6; 5–8 ng/ml, >6 months) with delayed start; mycophenolate mofetil (MMF); and low maintenance steroid with delayed start (POD 7) and tapering in the first year. One-year survival was 88.5%. Three patients died from infection (POD 12, 51, 351), and one from recurrence of cancer (POD 400). Incidence of severe infection was 17.9% (n = 5, respiratory tract). Within the first year, antibody-mediated rejection was detected in one patient (3.6%) and acute cellular rejection in four (14.3%). ECP with reduced-intensity immunosuppression is safe and effective in avoiding allograft rejection in HTX recipients with risk of severe infection or cancer recurrence. ER -