Improving treatment options to support solid organ transplantation

During the SOT Hub Steering Committee Meeting on September 9, 2026, key opinion leaders met to discuss treatment options to support solid organ transplantation (SOT). The meeting opened with a presentation by Markus Barten, followed by a panel discussion featuring Donna Mancini, Thomas Wekerle, Anna Reed, and Eric Epailly. 

During his presentation, Barten highlights current immunosuppressive strategies and ongoing unmet needs in SOT. He provides an overview of immunomodulatory approaches that may help reduce the immunosuppressive burden, such as extracorporeal photopheresis (ECP), and explores its proposed mechanism of action (Figure 1) and key clinical data supporting its use across SOT indications. He concludes by discussing future directions and the potential implications for broader clinical practice. Barten and the steering committee members go on to discuss the potential role of ECP across SOT settings, including its use in different graft complications, approaches to patient selection, and priorities for future research. 

Key points  

• There are several significant unmet needs in SOT, including the prevention and management of allograft rejection and the serious complications associated with long-term immunosuppression.¹
• Multidisciplinary risk stratification and precision diagnostics could support personalized immunosuppression strategies and the use of alternative immunomodulatory approaches, with the aim of reducing the immunosuppressive burden.^1,4–7
• ECP is an immunomodulatory therapy that does not cause generalized immunosuppression, with its effects mediated by the induction of leukocyte apoptosis and subsequent modulation of immune responses.¹
• Several retrospective and prospective studies have demonstrated the efficacy and safety of ECP in lung transplantation.¹
• Results from a randomized controlled trial (NCT05721079) showed that the addition of ECP to standard triple immunosuppression after lung transplantation resulted in a reduction of acute cellular rejection (ACR) and a lower incidence of chronic lung allograft dysfunction (CLAD).⁸
• The prospective, multicenter, open-label, randomized E-CLAD UK trial (ISRCTN10615985) will assess the addition of ECP to standard care in the treatment of bilateral lung transplantation recipients with CLAD.⁹
• Retrospective evidence for the use of ECP in heart transplantation has shown that ECP in combination with standard immunosuppression can reduce ACR episodes compared with standard immunosuppression alone.¹
• The American Society for Apheresis (ASFA) guidelines on the use of therapeutic apheresis in clinical practice include ECP as a Category II recommendation for heart transplantation in the treatment of cellular or recurrent rejection, and for rejection prophylaxis, and for lung transplantation in patients with CLAD, including bronchiolitis obliterans syndrome.¹⁰
• Early retrospective evidence suggests ECP may help stabilize or improve graft function in kidney transplantation, with evidence in liver transplantation emerging from small case series, pilot studies, and anecdotal reports.^1,11
• A survey of 51 transplant clinicians highlighted factors that would encourage greater use of ECP in transplant management across indications, with top reasons including more robust clinical trial data and the development of a standardized protocol (Figure 2).¹¹
• The potential role of ECP in preventing and managing rejection, particularly in high-risk or sensitized patients, remains an important area of investigation.¹
• ECP may have broad potential as an effective therapy across a range of graft complications in appropriately selected patients, including acute and chronic rejection, recurrent ACR, progressive CLAD, antibody-mediated rejection, and in patients with recurrent infection.^1,9
  • In lung transplantation, improved phenotyping of CLAD may help identify patients most likely to benefit from ECP.^7,12
• Further evaluation is needed to better understand the mechanism of action, identify patients most likely to benefit, establish optimal timing and treatment protocols, and determine whether ECP can reduce immunosuppressive exposure and associated toxicities.¹

This educational resource is independently supported by Therakos. All content is developed by SES in collaboration with an expert steering committee. Funders are allowed no influence.