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INTRODUCTION

Photopheresis is chemotherapy done with a certain kind of 
light on blood outside the body. The blood is then placed
back into the body. The type of light used is psoralen ultra-
violet A.
	Photopheresis reduces the body's response to
foreign histocompatibility antigens that cause rejection.

TRIAL

For photopheresis, blood is taken from the body, lymphocyte
blood cells are exposed to a light-sensitive (photoactive)
compound called methoxsalen. The blood is then returned
to the body.
	Sixty consecutive heart transplant recipients took
either standard 3-drug immunosuppressive therapy -
cyclosporine, azathioprine, and prednisone; or standard
therapy plus photopheresis. The photopheresis group got 24
photopheresis treatments, each pair of treatments given on two
consecutive days, during the first six months after transplant.
	All heart biopsy samples were tested in a blinded
way at a central pathology lab. Blood from the subgroup of 34
patients (57%) who were enrolled at the nine American
medical centers was also tested for cytomegalovirus DNA.
	After 6 months of follow-up, the average number
of acute rejection episodes per patient was 1.44 in the standard-
therapy group versus 0.91 in the photopheresis group.
	Only 6 photopheresis patients had 2 or more
rejection episodes versus 13 in the standard therapy group.
There was no difference in survival at 6 and 12 months.
Infection risk was the same in both groups but cytomegalovirus
DNA was found far less often in the photopheresis patients.

Title:       Photopheresis for the prevention or rejection in cardiac transplantation.
Source:   N Engl J Med 1998 Dec 10;339(24):1744-51.
Authors: Barr ML, Meiser BM, Eisen HJ, Roberts RF, Livi U, Dall Amico R,
              Dorent R, Rogers JG, Radovancevic B, Taylor DO, Jeevanandam V,
              Marboe CC
PMID:   9845709
UI:         99049887