ECP for AMR in kidney transplant recipients at high risk of infection: A case series

Results from a single-center case series evaluating extracorporeal photopheresis (ECP) for biopsy-proven antibody-mediated rejection (AMR) in four kidney transplant recipients at high risk of infection were presented by Nikolina Basic-Jukic at the 31st International Congress of The Transplantation Society (TTS), September 20–23, 2026, Sydney, AU. Outcomes assessed included changes in graft function (estimated glomerular filtration rate [eGFR]), donor-specific antibody (DSA) trends, and infectious complications during follow-up.

Key data: At the time of reporting, three of the four patients were receiving ongoing ECP. Patient 1 (51-year-old male, refractory nocardia infection with brain abscesses) developed cytopenias after ECP procedures, and the graft was removed after ten procedures due to decompensated cryptogenic liver cirrhosis. In Patient 2 (36-year-old female, ECP for chronic AMR), DSA levels decreased from 17,000 to 10,000 units, with stable graft function. In Patient 3 (25-year-old male, second kidney transplant, ECP initiated after BK virus nephropathy and high DSA levels), DSA levels became negative after 18 ECP cycles, with stable allograft function. In Patient 4 (29-year-old female, second kidney transplant, BK virus nephropathy 2 months post-transplant), DSA levels became negative with ECP treatment, with stable kidney function and stable BK viral load.

Key learning: In this case series, ECP was a generally well-tolerated and clinically useful option for treating AMR in kidney transplant recipients at high risk of infection. Its favorable safety profile may allow effective rejection management while avoiding further infectious complications.