Ultraviolet irradiation-based cell therapy reduces the risk of rejection and infection in lung transplant patients

Researchers from the MedUni Vienna Lung Transplant Program and the University Hospital of Vienna have published in the European Respiratory Journal the results of the first prospective, randomized and controlled study on the use of extracorporeal photopheresis (ECP) in lung transplantation. The findings may significantly alter the standard treatment of rejection reactions after lung transplantation.

Extracorporeal photopheresis (ECP) is a cell therapy based on ultraviolet light that was originally developed for the treatment of skin cancer (T-cell lymphoma), and since the early 1990s has also been used to treat chronic rejection after lung transplantation. In the current study, the Vienna Lung Transplant Program pioneered the use of ECP and applied it to treat acute and chronic rejection reactions as well as some antibody problems.

Based on these results, a randomized trial with a control group was conducted for the first time to investigate whether ECP can help prevent rejection reactions after lung transplantation in addition to a standard immunosuppression regimen. The aim of the study was to prevent acute rejection episodes and reduce the risk of early chronic rejection.

Research that can change the approach

The current standard procedure after lung transplantation is triple immunosuppression, sometimes combined with induction therapy. Although this procedure works well in other transplants, the incidence of acute rejection in lung transplantation is 10-50% during the first year. Treatment for such rejection usually involves treatment with high doses of cortisone (“pulse therapy”) or the use of special antibodies, which has serious side effects and increases the risk of chronic rejection.

Studies conducted at MedUni Vienna and the University Hospital of Vienna have 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 sequential steps: first, blood is drawn 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 ultraviolet light and leads to cell apoptosis, a kind of “controlled suicide”.

“Although clinical experience in various transplant settings has shown promising results, most of the data comes from single-center studies, which often lacked a suitable control group and used ECP only in selected patients. In our study, we took all this into account and were 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.

Additional benefits include fewer hospitalizations and a minimally invasive treatment without toxic effects, making it safe and generally well tolerated.

Preventive therapy in the concept of personalized immunosuppressive medicine

The Vienna Lung Transplant Program study showed that existing immunosuppression protocols after lung transplantation still need to be improved. With ECP, long-term patient outcomes can be significantly improved, which makes its use in prophylactic therapy feasible. In addition, the study was able to set new standards for rejection rates and mortality – another step towards personalized immunosuppressive medicine after lung transplantation.