AUTHOR=Cashmore Sarah-Jane , Barten Markus Johannes , Diekmann Fritz , Epailly Eric , Fisher Andrew J. , Gennery Andrew R. , Gibbons Ben , Gökler Johannes , Guest Julie , Heng Anne-Elisabeth , Hutchinson James A. , Rampino Teresa , Vos Robin , Potena Luciano 

TITLE=Current Usage of Extracorporeal Photopheresis in Solid Organ Transplantations in Europe: A Narrative Review

JOURNAL=Transplant International

VOLUME=Volume 38 - 2025

YEAR=2025

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2025.14906

DOI=10.3389/ti.2025.14906

ISSN=1432-2277

ABSTRACT=Solid organ transplantation (SOT) faces significant challenges in managing allograft rejection, with current immunosuppressive therapies often associated with substantial adverse effects. Extracorporeal photopheresis (ECP) has emerged as a promising adjunctive treatment for rejection prevention and management in heart and lung transplants, with growing evidence supporting its use in kidney and liver transplants. Despite this, the availability of ECP and its place in standard treatment pathway is widely variable across Europe. This narrative review, supported by a European survey of 51 transplant clinicians, highlights the current usage of ECP in SOT. Findings reveal that ECP is primarily used for recurrent rejection in heart and lung transplants, with limited application currently in kidney and liver transplants. ECP has shown some efficacy in managing acute and chronic rejection, and stabilizing graft function. Barriers including lack of standardized protocols, availability of ECP, lack of high-quality clinical trial data and lack of a defined mechanism of action hinder its broader adoption. Future directions include the development of standardized protocols, multicenter registries, and further controlled clinical trials to define the role of ECP. Increased awareness, cost-effectiveness studies, mechanistic studies and equitable access are essential to integrate ECP into routine SOT management.