Extracorporeal Photopheresis, a Therapeutic Alternative for T cell-mediated Rejection in Renal Transplantation.

T-cell mediated rejection (TCMR) in renal transplantation, although reduced by better immunosuppressants, still impacts graft survival. TCMR responds to methylprednisolone (MPL) in 60% to 70% of cases, with polyclonal anti-T-lymphocyte antibodies (ATGs) used for severe or corticoresistant cases. When ATG is contraindicated, extracorporeal photopheresis (ECP) may be an alternative. ECP involves treating immune cells with 8-methoxypsoralen and ultraviolet-A radiation before reinjection, with effect in various T-cell-mediated and autoimmune diseases. This study included two renal transplant recipients with severe TCMR. Patient 1's creatinine levels were 1.4 mg/dL baseline, 2.2 mg/dL at TCMR diagnosis, and 1.9 mg/dL at ECP initiation. Patient 2's levels were 1 mg/dL baseline, 1.8 mg/dL at diagnosis, and 1.42 mg/dL at ECP initiation. The THERAKOS CELLEX system was used for patient 1, and the OPTIA system was used for patient 2, both with methoxsalen. ECP is highlighted as a viable option for TCMR in renal transplantation when conventional treatments are unsuitable.