Journal article
Extracorporeal photopheresis to attenuate decline in lung function due to refractory obstructive allograft dysfunction
Transfusion medicine (Oxford, England), Vol.31(4), pp.292-302
08/2021
DOI: 10.1111/tme.12779
PMCID: PMC8453798
PMID: 33955079
Abstract
This study was designed to prospectively evaluate the efficacy of extracorporeal photopheresis (ECP) to attenuate the rate of decline of FEV
in lung transplant recipients with refractory bronchiolitis obliterans. Due to an observed higher than expected early mortality, a preliminary analysis was performed.
Subjects from 10 lung transplant centres were assigned to ECP treatment or to observation based on spirometric criteria, with potential crossover for those under observation. The primary endpoint of this study was to assess response to ECP (i.e., greater than a 50% decrease in the rate of FEV
decline) before and 6 months after initiation of ECP. Mortality was also evaluated 6 and 12 months after enrolment as a secondary endpoint.
Of 44 enrolled subjects, 31 were assigned to ECP treatment while 13 were initially assigned to observation on a non-random basis using specific spirometric inclusion criteria (seven of the observation patients subsequently crossed over to receive ECP). Of evaluable patients, 95% of patients initially assigned to treatment responded to ECP with rates of FEV
decline that were reduced by 93% in evaluable ECP-treated patients. Mortality rates (percentages) at 6 and 12 months after enrolment was 32% and 41%, respectively. The most common (92%) primary cause of death was respiratory or graft failure. Significantly (p = 0.002) higher rates of FEV
decline were observed in the non-survivors (-212 ± 177 ml/month) when compared to the survivors (-95 ± 117 ml/month) 12 months after enrolment. In addition, 18 patients with bronchiolitis obliterans syndrome (BOS) diagnosis within 6 months of enrolment had lost 38% of their baseline lung function at BOS diagnosis and 50% of their lung function at enrolment.
These analyses suggest that earlier detection and treatment of BOS should be considered to appreciate improved outcomes with ECP.
Details
- Title: Subtitle
- Extracorporeal photopheresis to attenuate decline in lung function due to refractory obstructive allograft dysfunction
- Creators
- Chadi A Hage - Indiana UniversityJulia Klesney-Tait - University of IowaKeith Wille - University of AlabamaSelim Arcasoy - Columbia Southern UniversityGordon Yung - University of California San DiegoMarshall Hertz - University of MinnesotaKevin M Chan - University of MichiganMatt Morrell - University of PittsburghHilary Goldberg - Brigham and Women's HospitalSuresh Vedantham - Washington University in St. Louis School of MedicineMary Clare Derfler - Washington University in St. Louis School of MedicinePaul Commean - Washington University in St. Louis School of MedicineKeith Berman - Health Research Associates, Mountlake Terrace, Washington, USA.Ed Spitznagel - Department of Mathematics, Washington University, St. Louis, Missouri, USAJeff Atkinson - Department of Internal Medicine, Division of Pulmonary Medicine, Washington University School of Medicine, St. Louis, Missouri, USAGeorge Despotis - Washington University in St. LouisEPI Study Group
- Resource Type
- Journal article
- Publication Details
- Transfusion medicine (Oxford, England), Vol.31(4), pp.292-302
- DOI
- 10.1111/tme.12779
- PMID
- 33955079
- PMCID
- PMC8453798
- NLM abbreviation
- Transfus Med
- ISSN
- 0958-7578
- eISSN
- 1365-3148
- Grant note
- P30 DK054759 / NIDDK NIH HHS NCT02181257 / Therakos®, Inc. CAG-00324R2 / US Centers for Medicare and Medicaid Services (CMS)
- Language
- English
- Date published
- 08/2021
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984359819102771
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