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• W4387248916 abstract "SESSION TITLE: Transplantation Posters 3 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Chronic lung allograft dysfunction (CLAD) is a threat to the long-term survival of lung transplant recipients. Recently, extracorporeal photopheresis (ECP), has been used as a treatment option for patients with CLAD. Herein, we present a matched retrospective study of the efficacy and safety of ECP for CLAD of any phenotype. METHODS: We performed a retrospective cohort study of adults >18 yr who developed CLAD post lung or heart and lung transplant at Mayo Clinic, Rochester from Jan 1, 2009, through Mar 31, 2022. Patients were identified from our Transfusion Medicine and transplant database. Those patients who have lived for >1 yr post transplant were included. ECP recipients were matched 1:1; first based on CLAD phenotype then transplant type. We also matched on age at transplant, when able. Patients with undefined phenotype were matched to closest phenotype (BOS for those patients). Demographic data were compared by non-parametric testing and outcomes by Wald chi square. Post-transplant best FEV1 (baseline) and CLAD phenotype were defined by current ISHLT guidelines and reviewed independently and in duplicate by two trained physicians. RESULTS: We identified 13 patients who received ECP for CLAD. We were only able to match 12 patients to non-ECP-treated CLAD patients. There were no significant differences in age, sex, native lung disease, comorbidities, CLAD grade, and immunosuppression at the time of CLAD diagnosis among two groups. Median days to CLAD diagnosis of cases were 1445.5 (IQR:612.5, 1832.5) vs 1312.5 (IQR:926.5, 1491.25, p = 0.68) in controls. Baseline FEV1 of cases was 2.86 L (IQR:2.38, 3.69) vs 2.67 L (IQR:2.47, 3.26, p = 0.81) in controls. FEV1 of cases declined to median of 1.785L (IQR:1.598, 2.098) compared to controls 1.795L (IQR:1.425, 2.220, p = 0.90) at diagnosis of CLAD. Median time from CLAD to ECP initiation was 29.5 days (IQR:14.75, 93.5). Patients underwent a median of 32 cycles (IQR:18.75, 54.5) over median of 624 days (IQR:259, 1093). There were no significant differences in the percentage decline in FEV1 among groups from baseline to 6 months [ECP: 53.76 (IQR:37.280, 64.84) vs control: 46.05 (IQR:26.72, 57.59, p=0.398)] and baseline to 12 months [ECP: 54.53 (IQR:47.43, 63.04) vs control: 41.58 (IQR:24.98, 62.97, p=0.290)] post CLAD diagnosis. Similarly, no differences in the rates of death within a year of CLAD diagnosis 2 (17%) vs 2 (17%) [OR:1, 95% CI:0.11-8.55] and at last follow 7 (58%) vs 8 (67%) [OR 1.4, 95% CI:0.27-7.51] among the two groups. Median time to last chart extraction or death from CLAD diagnosis was 998.5 days (IQR:628.7, 1785) in cases and 1589 days (IQR:831.7, 2025.7) in controls. The only ECP-related complications reported were line infections (2, 16.7%). CONCLUSIONS: In our single center cohort, ECP appeared safe, but there was no significant difference in FEV1 decline between patients who received ECP compared to CLAD phenotype matched controls. CLINICAL IMPLICATIONS: There is minimal data for the effective treatment of CLAD despite its crucial impact on the long-term survival of lung transplant recipients. Multicenter, prospective studies are needed to evaluate the utility of immunomodulatory therapies such as ECP for CLAD treatment. DISCLOSURES: No relevant relationships by Cassie Kennedy No relevant relationships by Kelly Pennington No relevant relationships by Steve Peters No relevant relationships by John Scott No relevant relationships by Abdul Wahab No relevant relationships by Jeffrey Winters No relevant relationships by Mark Wylam No relevant relationships by Hemang Yadav" @default.
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• W4387248916 date "2023-10-01" @default.
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• W4387248916 title "IMPACT OF EXTRACORPOREAL PHOTOPHERESIS ON LUNG FUNCTION AND MORTALITY IN CHRONIC LUNG ALLOGRAFT DYSFUNCTION" @default.
• W4387248916 doi "https://doi.org/10.1016/j.chest.2023.07.4140" @default.
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