The technique involves three stages: 1-leucapheresis, 2- photoactivation with photosensitizer plus UV A irradiation, and 3- re-infusion of the buffy coat.
Extra Corporal Photopheresis (ECP) was first introduced for the treatment of Cutaneous T-Cell Lymphoma. Now has been widely used in the treatment of acute allograft rejection; most extensively in cases of cardiac transplant rejection. It has also shown success and high efficacy in reversing renal allograft rejection as well. Only one cohort study has been done by Jardine et al; ECP been used in 10 kidney recipients with therapy resistant rejection, and to our surprise, it showed that rejection has been resolved in all patients treated with ECP!
The exact mechanism of action remains unclear, but believe it has an immunomodulatory rather than immunosuppressive effect: The irradiation therapy induces high rate of apoptosis of the T-cells with sparing of the monocytes, and this eventually creates changes in the patient’s cytokine profile towards “type 2” cytokines; with significant increase of IL-5 and decrease of IFN-Gamma - “which is associated with allograft rejection!” also, it has a stimulatory effect on the T-regulatory cells as well..
Safety profile is excellent with <1% adverse effect, considered more safe than any other modality of apheresis!
ECP been mainly used for CTCL, and GVHD. Also, has been used in other autoimmune diseases including MS, scleroderma, DM-1, RA, psoriasis, Crohn’s, Nephrogenic Fibrosing Dermopathy. ECP is an effective, tolerable, and safe immunomodulatory therapy that can be used theoretically for resistant renal allograft rejection “T-cell rejection”. We still need more data and large cohort trials for this promising technique/therapy.
- ► 2020 (32)
- ► 2019 (42)
- ► 2018 (57)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- ► 2011 (370)
- Virtual Grand Rounds in Nephrology- E nephrology
- ASN's review on the ESRD bundling
- TOPIC DISCUSSION: EFFECT OF PROTEINURIA on combina...
- Poem from Pediatric Nephrologist
- TOPIC DISCUSSION: ACE induce angioedema replaced b...
- Nephsap review: Chronic Kidney Disease : CKD patie...
- Nephsap review: Chronic Kidney Disease: Troponin T...
- Bundled Payment for ESRD
- 2010 North American Dialysis and Transplantation (...
- Hematuria and Donation?
- TOPIC DISCUSSION: Do Peritoneal Dialysis patients ...
- Renal Fellow Network: Deciphering the pathologists...
- TOPIC DISCUSSION: TIDAL PD
- TOPIC DISCUSSION: DEXA SCAN in TRANSPLANT PATIENTS?
- CLINICAL CASE 21, ANSWERS AND SUMMARY
- Plagiarism In Application Essays????
- Micro RNAs and Transplantation
- IN THE NEWS: Anabolic Steroids and FSGS
- CLINICAL CASE 20, ANSWERS AND SUMMARY
- Pediatrics Grand rounds continue
- CONSULT ROUNDS: Severe Pre eclampsia
- Milk and CKD
- Transplant/Immunology Quiz 3 answers
- Rituximab and Cyclophosphamide: A Tale of Two Trea...
- CONSULT ROUNDS: HUS/TTP During Pregnancy
- IN THE NEWS: FACTOR H REPLETION in Atypical HUS
- Leflunomide and liver failure
- TOPIC DISCUSSION: Gadolinium and NSF- How to image...
- Lupus Nephritis Post Transplant
- Why do Internal Medicine Residents Choose Nephrolo...
- TOPIC DISCUSSION: TTP/HUS
- CONSULT ROUND: Hypercalcemia and Lithium
- CONSULT ROUND: ATHEROEMBOLIC DISEASE
- CONSULT ROUNDS:Rare and Interesting Cause of Hyper...
- TOPIC DISCUSSION: URR and Kt/V
- Organ Trading Discussion
- Dietary Management of Hypertension
- Chronic Dialysis: Now or Later?
- Photopheresis therapy for renal allograft rejection?
- IN THE NEWS --->google as a diagnostician
- Live Donor Nephrectomy with vaginal extraction
- CLINICAL CASE 19, ANSWER AND SUMMARY
- IN THE NEWS- HYPOMAGNESEMIA AND PPI?
- JOB MARKET for RENAL FELLOWS
- Nephron Power: NYSN Fellows Boot camp
- NYSN Fellows Boot camp
- TOPIC DISCUSSION: captopril and stones?
- Topic Discussion: D-Lactate vs D-lactic acid
- ▼ July (48)