Initiation of extracorporeal photopheresis in lung transplant patients with mild to moderate refractory BOS: a single-center real-life experience - 26/04/22

Doi : 10.1016/j.resmer.2022.100913

Justine Leroux ¹ , Sandrine Hirschi ¹ , Arnaud Essaydi ² , Alain Bohbot ³ , Tristan Degot ¹ , Armelle Schuller ¹ , Anne Olland ¹ , Romain Kessler ¹ , Benjamin Renaud-Picard ^1,^⁎
¹ Strasbourg Lung Transplant Program, Hôpitaux universitaires de Strasbourg, Strasbourg, France
² Clinical Transplantation Laboratory, Établissement Français du Sang Grand-Est, Strasbourg, France
³ Department of Cancerology, ICANS - Institut Cancérologie Strasbourg Europe, Strasbourg, France

^⁎Corresponding author: Dr Benjamin Renaud-Picard, Department of Respirology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, F- 67000 Strasbourg. Tel: +33 3 69 55 01 82. Fax: +33 369 55 18 74.Department of RespirologyNouvel Hôpital CivilUniversity Hospital of Strasbourg1 Place de l'HôpitalStrasbourgF- 67000

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ABSTRACT

Background

Bronchiolitis obliterans syndrome (BOS) is the main limitation to long-term survival following lung transplantation. Several studies generated promising results regarding the efficacy of extracorporeal photopheresis (ECP) in BOS management. We aimed to compare FEV1 evolution in ECP-treated versus non-ECP treated patients among BOS recipients.

Methods

Overall, 25 BOS patients were included after receiving optimized treatment. Data were collected retrospectively. Twelve patients with moderate and refractory BOS received ECP treatment.

Results

Among non-ECP treated control patients (n=13), six experienced persistent decline without undergoing ECP for various reasons. ECP stabilized pre-ECP lung function during the subsequent 6 to 24 months (repeated measures one-way Anova, p=0.002), without any significant impact observed by either FEV1 decline speed prior to ECP or time between BOS diagnosis and ECP onset. ECP-treated patients displayed a similar risk of an additional permanent 20% or higher drop in FEV1 after BOS onset compared to controls, but a lower risk compared to control decliners (p=0.05). ECP quickly stabilized FEV1 decline in refractory BOS patients compared to non-treated decliners.

Conclusions

We confirmed that this therapeutic option against refractory BOS can be managed in a medium-size LTx center, with a satisfactory efficacy and an acceptable tolerance.

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KEYWORDS : Lung transplantation, extracorporeal photopheresis, bronchiolitis obliterans syndrome

Plan

Extracorporeal photopheresis protocol

General characteristics

Extracorporeal photopheresis-related specific characteristics

FEV1 evolution prior and after ECP onset

Clinical factors affecting the FEV1 response post-ECP

Risk assessment of additional permanent 20% or higher FEV1 drop after BOS onset

DISCUSSION

Contribution of each author

Uncited References

	Acknowledgments The authors would like to thank all the persons who contributed to the realization of this study.
	Funding We do not have any funding to disclosure for this study.
	Approval: Authorization was obtained from the patient to write this study.