KIDNEY

• Introduction

  Extracorporeal photopheresis (ECP) is an emerging immunomodulatory therapy with promising applications in kidney transplantation. While its use is well established in heart, liver, and lung transplants, its role in renal transplantation remains underexplored. Traditional immunosuppressive therapies have significantly improved short-term graft survival. However, long-term outcomes remain challenging and there is currently no effective treatment for chronic antibody-mediated rejection. 

  
  

  In this talk, we will explore the potential of ECP in managing both acute and chronic antibody-mediated rejection, preventing rejection episodes, and reducing the burden of conventional immunosuppression. Although clinical evidence is still limited and ECP is not yet recommended by current ASFA guidelines, its ability to promote immune tolerance and modulate alloimmune responses makes it a promising option in the management of kidney transplant patients. Importantly, ECP is well tolerated and free of significant side effects, making it an attractive adjunctive therapy. Nevertheless, randomised controlled trials are urgently needed to validate its efficacy and define its role in clinical practice.
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  Application in different organs - Kidney
  

  
  

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• Self-assessment quiz

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• The Science of ECP in Solid Organ Transplantation programme: Kidney Transplantation H5P

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• Suggested resources

• • Long-term kidney transplant graft survival-Making progress when most needed. Poggio ED et al, Am J Transplant 2021;21:2824-2832
  • Understanding the causes of kidney transplant failure: the dominant role of antibody-mediated rejection and nonadherence. Sellarés J, Am J Transplant 2012; 12:388-399
  • Complement-binding anti-HLA antibodies and kidney-allograft survival. Loupy A et al, N Engl J Med 2013;369(13):1215-26
  • Recent insights into extracorporeal photopheresis for graft-versus-host disease. Del Fante C, Expert Rev Clin Immunol 2024 Apr;20(4):339-348
  • Taiman M et al, Transfusion and Apheresis Science  58 ( 2019) 515 -524
  • Photopheresis Abates the Anti-HLA Antibody Titer and Renal Failure Progression in Chronic Antibody-Mediated Rejection. Gregorini M et al, Biology 2021;10,547
  • Lionet A et al, Transplant. Direct 2024;10:e 1578
  • Extracorporeal photopheresis as an antirejection prophylaxis in kidney transplant recipients: preliminary results. Kusztal M et al,  Transplant. Proceedings 2011; 43, 2938-2940