Extracorporeal Photopheresis as an Immunomodulatory Bridge in Kidney Transplant Recipients With Infections and Concomitant Donor-Specific Antibodies: A Case Series.

INTRODUCTION

Kidney transplant recipients with severe infections often require immunosuppression minimization, increasing the risk of donor-specific antibody (DSA) persistence and antibody-mediated injury. Extracorporeal photopheresis (ECP) may provide immunomodulation while limiting alloimmune activation.

METHODS

We retrospectively analyzed four kidney transplant recipients with severe infectious complications and concomitant DSAs who required immunosuppression reduction. Clinical scenarios included BK viremia, BK virus nephropathy, Epstein-Barr virus-associated post-transplant lymphoproliferative disorder, and recurrent urinary tract infections. ECP was administered for 12 months as adjunctive therapy.

RESULTS

Following ECP initiation, infectious complications improved or resolved in all patients, with reduction of viral replication when present. DSA levels decreased markedly in all cases. Kidney graft function remained stable throughout follow-up, and no episodes of acute rejection were observed.

CONCLUSION

ECP may represent a safe and effective immunomodulatory bridge during immunosuppression minimization in kidney transplant recipients with infections and concomitant DSAs.