Researchers from the Vienna Lung Transplant Program of MedUni Vienna and University Hospital Vienna have published the first prospective, randomized and controlled study on the use of extracorporeal photopheresis (ECP) in lung transplantation in the renowned European Respiratory Journal. The findings could significantly change the standard procedure for rejection reactions after lung transplants.
Extracorporeal photopheresis (ECP) is a cell therapy based on UV light that was originally developed for the treatment of skin cancer (T-cell lymphomas) and has also been used since the early 1990s to treat chronic rejection following lung transplantation. With the current study, the Vienna Lung Transplant Program has pioneered the use of ECP and applied it to the treatment of acute and chronic rejection reactions as well as certain antibody problems. Based on the resulting findings, a randomized study with a comparison group was conducted for the first time to examine the extent to which ECP can help prevent rejection reactions after lung transplantation in addition to a standard immunosuppression regimen. The aim was to prevent acute rejection episodes and reduce the risk of early chronic rejection.
Study with approach-changing potential
The current standard procedure after lung transplantation is for patients to receive triple immunosuppression, sometimes in combination with induction therapy. Although this procedure works well for other transplants, the acute rejection rate for lung transplants is 10-50 percent in the first year. Treatment of this rejection usually involves high-dose cortisone treatment (“pulse” therapy) or the use of special antibodies, which has serious side effects and increases the risk of chronic rejection. Research at MedUni Vienna and University Hospital Vienna has shown that the use of ECP leads to a statistically significant reduction in the number and severity of acute rejection episodes. ECP consists of two consecutive steps: First, blood is taken from the patient to collect mononuclear cells. These cells are then exposed to 8-methoxypsoralen (8-MOP) — a biologically inert substance that does not interact with human tissue but reacts with UVA light and leads to apoptosis of the cells, a kind of “controlled suicide.”
“Although clinical experience in different transplant settings has shown promising results, much of the data comes from single-center studies that often lacked a suitable control group and used ECP only in selected patients. Our study takes all of this into account and was able to show that the use of ECP reduces the risk of chronic rejection and infection,” emphasizes Peter Jaksch, Head of Internal Medicine at the Vienna Lung Transplant Program. Further advantages of ECP are the reduced number of hospital stays and the minimally invasive treatment without toxic effects, making it a safe treatment that is generally well tolerated.
Prophylactic therapy in the concept of personalized immunosuppressive medicine
The study of the Vienna Lung Transplant Program was able to show that current protocols for immunosuppression after lung transplantation still have room for improvement. With the use of ECP, the long-term results of patients could be significantly improved, which makes it possible to use it in prophylactic therapy. In addition, the study was able to set new standards in the area of rejection rates and mortality — a further step towards personalized immunosuppressive medicine after lung transplantation.
“This study would not have been possible without the collaboration of various disciplines and stakeholders. Special mention should be made of Robert Knobler as a pioneer of ECP in Vienna, with whom we have been working for more than 10 years. In addition, the close collaboration between the Department of Dermatology, the Department of Transfusion Medicine and Cell Therapy, the Transplantation Immunology at the Department of General Surgery and the Department of Thoracic Surgery has once again shown how well the multidisciplinary collaboration at MedUni Vienna and Vienna General Hospital works,” explains Alberto Benazzo, Surgical Director of the Vienna Lung Transplant Program.
Following the study, a multicenter project will now confirm the results. Furthermore, it is of great importance to understand the mechanisms behind the therapy in order to further strengthen the protective effect of ECP — based on this, an optimal treatment regimen can then be developed.