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Avoiding calcineurin inhibitors in the early post‐operative course in high‐risk liver transplant recipients: The role of extracorporeal photopheresis

The aim of this work is to report on the results of a single‐center, prospective study on the feasibility of calcineurin‐inhibitor (CNI)‐staggered immunosuppression by use of extracorporeal photopheresis (ECP) in liver transplant (LT) recipients at risk of renal and neurological complications.Patients were matched on a 1:1 basis with historical controls on standard CNI immunosuppression. ECP patients were treated with ECP plus antimetabolites and/or steroids, while CNIs were withheld until clinically indicated. Thirty‐six patients were evaluated: 18 ECP patients and 18 controls. ECP was tolerated in 100% of cases. CNI were introduced at a median of 8 days (4–55) in 17 ECP patients, while one patient was on a fully CNI‐sparing regimen 22 months after LT. Acute rejection occurred in 27.7% patients in ECP (5/18) versus 16.7% in controls (3/18) (P = ns) with a shorter time to rejection in ECP (36 ± 31.3 days vs. 83.6 ± 65.6 days; P = ns). All rejection episodes were amenable to medical treatment. Neurological and renal complications occurred in 22.2% (4/18) of patients in either group, but led to in‐hospital mortality in 3 patients among controls versus 1 in ECP (P = ns). One‐, 6‐, and 12‐month survival rates were 94.4, 88.1, and 88.1% in ECP versus 94.4, 77.7, and 72.2% among controls (P < 0.0001). ECP seems to allow for management of high‐risk LT recipients in the early post‐transplant course and reduction of CNI‐related mortality. Continued data validation is favored to assess the impact of ECP on long‐term graft and patient survival. J Clin Apheresis 2007. © 2007 Wiley‐Liss, Inc.