Exploring the Role of Extracorporeal Photopheresis in Kidney Transplant Management

Extracorporeal photopheresis (ECP) is emerging as an apoptotic cell-based therapy that suppresses alloimmunity, promotes donor-specific regulation, and reduces the need for conventional maintenance immunosuppression. ECP therapy is associated with regulatory T-cell proliferation, anti-inflammatory effects, and reduction of anti-HLA antibodies, making ECP a possible alternative or adjunct treatment for preventing and treating transplant rejection. Presently, we have a limited understanding of the mechanisms of ECP action, and clinical evidence for efficacy in kidney transplantation is sparse. Promising results in acute cellular or antibody-mediated rejection were reported, but beneficial effects in chronic settings are less evident. The absence of reliable markers for patient stratification and therapeutic monitoring further complicates its application. Working with the European Union–funded exTra network, our group is studying the therapeutic action of ECP in kidney transplantation with the ultimate goal of conducting a large multicenter study to standardize and harmonize treatment indications and approaches.