Successful reversal of recalcitrant hepatic allograft rejection by photopheresis

Extracorporeal photopheresis (ECP) is an immunologic modality that has show n efficacy in the treatment of clonal T-cell diseases, including Sezary syn drome and allograft rejection. In this case report, we expand on this obser vation to include recalcitrant hepatic allograft rejection. A 14-year-old b oy with hepatic allograft rejection refractory to high-dose corticosteroid and lymphocytolytic therapy was treated with 4 sessions of ECP over a 6-wee k period. After 2 sessions, a liver biopsy showed complete reversal of acut e cell-mediated rejection. No opportunistic infections or other adverse eve nts were noted. Photopheresis appears to be a safe and effective modality f or the treatment of refractory hepatic allograft rejection.