Extracorporeal Photopheresis and Heart Transplantation; A Comprehensive Review of Current Evidence

Despite significant advancements in heart transplantation (HTx) techniques and the development of immunosuppressive (IS) medications, rejection remains a persistent challenge. Additionally, IS medications are associated with various complications, highlighting the need for alternative therapeutic interventions. Extracorporeal photopheresis (ECP) has emerged as a promising adjunctive therapy. Initially approved for the treatment of cutaneous T-cell lymphoma, ECP has expanded its applications to include both the prophylaxis and treatment of HTx rejection. However, the available data remain limited, necessitating a comprehensive review to better understand its role. This article aims to evaluate the existing literature on ECP, focusing on its mechanisms and its potential in both the preventive and therapeutic management of HTx rejection. This comprehensive evaluation is intended to guide future research efforts, which could include well-designed clinical trials and real-world studies to address the limitations of current data. Ultimately, our goal is to provide a robust framework for integrating ECP into HTx management protocols, ensuring that its potential benefits are fully realized for both prophylactic and therapeutic applications.