PMID- 8116042
OWN - NLM
STAT- MEDLINE
DCOM- 19940329
LR  - 20211203
IS  - 0041-1337 (Print)
IS  - 0041-1337 (Linking)
VI  - 57
IP  - 4
DP  - 1994 Feb 27
TI  - Reduction of the incidence of rejection by adjunct immunosuppression with 
      photochemotherapy after heart transplantation.
PG  - 563-8
AB  - In this study, photochemotherapy (PCT) was used for adjunct immunosuppression in 
      the first six months after heart transplantation (HTx). Fifteen patients after 
      orthotopic HTx were included in the study; all received standard triple-drug 
      immunosuppression including cyclosporine, azathioprine and glucocorticoids, but 
      no adjunct therapy with mono- or polyclonal antibodies. The patients were divided 
      into three groups: group I served as control with no additional treatment; group 
      II received adjunct treatment with 10 courses of PCT (single-day treatments); and 
      group III received 20 PCT courses since it was given each time on two consecutive 
      days. PCT was started in both groups on day one after HTx; it was applied with a 
      higher frequency in the early postoperative period and thereafter continued at 
      four-week intervals for a total of 6 months. The photopheresis method for PCT 
      included extracorporeal UVA irradiation of mononuclear cells that were treated 
      with the photosensitive drug 8-methoxypsoralen (8-MOP) and subsequently 
      retransfused to the patient. A new liquid form of 8-MOP was added directly to the 
      buffy coat, resulting in reliable and sufficient drug levels in the cell 
      suspension during the irradiation period; problems caused by oral application due 
      to unpredictable variations in gastrointestinal absorption were thus prevented. 
      Analysis of the total numbers of acute rejection episodes (AREs) within the first 
      four weeks after HTx revealed a more impressive decrease by double PCT (group 
      III, 3 AREs) than by single PCT (group II, 5 AREs) in comparison with the control 
      (group I, 6 AREs). Over the total observation time (mean: 9.6 months), however, 
      both PCT schedules reduced the total number of AREs observed in the control group 
      (20 AREs) equally by more than 50% (9 AREs each in groups II and III) (P = 
      0.007). Furthermore, PCT treated patients had significantly fewer infections (6 
      infections in each group) than control group patients (15 infections) (P = 
      0.026); this, however, may be accounted for by the higher number of acute 
      rejections in the control group and consequent increase in unspecific 
      immunosuppression treatment. Our results suggest that PCT is a safe and effective 
      method of adjunct immunosuppression that can be applied early in the 
      postoperative period; it reduces the number of rejection episodes and does not 
      increase the risk of infections.
FAU - Meiser, B M
AU  - Meiser BM
AD  - Department of Cardiac Surgery, Ludwig-Maximilians University of Munich, 
      Grosshadern Medical Center, Germany.
FAU - Kur, F
AU  - Kur F
FAU - Reichenspurner, H
AU  - Reichenspurner H
FAU - Wagner, F
AU  - Wagner F
FAU - Boos, K S
AU  - Boos KS
FAU - Vielhauer, S
AU  - Vielhauer S
FAU - Weiss, M
AU  - Weiss M
FAU - Rohrbach, H
AU  - Rohrbach H
FAU - Kreuzer, E
AU  - Kreuzer E
FAU - Uberfuhr, P
AU  - Uberfuhr P
AU  - et al.
LA  - eng
PT  - Clinical Trial
PT  - Controlled Clinical Trial
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - U4VJ29L7BQ (Methoxsalen)
SB  - IM
MH  - Adult
MH  - Biopsy
MH  - Communicable Diseases/complications
MH  - Graft Rejection/*prevention & control
MH  - Heart Transplantation/*immunology/pathology
MH  - Humans
MH  - Immunosuppression Therapy/*methods
MH  - Leukapheresis
MH  - Methoxsalen/*therapeutic use
MH  - Middle Aged
MH  - *Photochemotherapy
EDAT- 1994/02/27 00:00
MHDA- 1994/02/27 00:01
CRDT- 1994/02/27 00:00
PHST- 1994/02/27 00:00 [pubmed]
PHST- 1994/02/27 00:01 [medline]
PHST- 1994/02/27 00:00 [entrez]
PST - ppublish
SO  - Transplantation. 1994 Feb 27;57(4):563-8.