Single-field total lymphoid irradiation in the treatment of refractory rejection after heart transplantation

Nine heart transplant recipients were treated with single-field total lymph oid irradiation (TLI) for early (<1 year) or late (>1 year) rejection that was refractory to multiple regimens of immunosuppressive therapy. For patie nts with early rejection (n = 6), the rejection frequency (rejections/patie nt/month) decreased from pre-TLI of 1.63 to post-TLI of .02 (p < .001), and for patients with late rejection (n = 3), the rejection frequency decrease d from pre-TLI of .23 to post-TLI of .05 (p < .02). The reduced rejection f requencies have been maintained for a mean follow-up of 28.6 (8 to 78) mont hs, and adverse events during or late after TLI were uncommon. Single-field TLI is a safe and effective technique in the management of refractory reje ction early or late after heart transplantation.