{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:21:55Z","timestamp":1787721715313,"version":"build-2784847793"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Backgrounds<\/jats:title>\n                    <jats:p>Extracorporeal photopheresis (ECP) is a promising immunomodulatory strategy for complex rejection in heart transplant (HTx) recipients. By combining leukapheresis, 8\u2010methoxypsoralen photoactivation, and UVA irradiation, ECP induces leukocyte apoptosis and promotes immune tolerance through dendritic\u2010cell modulation, regulatory T\u2010cell expansion, and cytokine reprogramming. Clinical evidence supports its use in steroid\u2010refractory acute cellular rejection (ACR) and selected antibody\u2010mediated rejection (AMR). This study reviews the mechanistic rationale and clinical evidence for ECP and reports the real\u2010world experience of the Azienda Ospedaliera Universitaria Senese (AOU Senese).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed a single\u2010centre cohort of 19 heart transplant recipients treated with extracorporeal photopheresis at AOU Senese between March 2010 and November 2024. Clinical, histological, immunological, echocardiographic, biomarker, immunosuppressive\u2010treatment, and safety data were extracted at baseline and at dataset\u2010defined 3\u2010, 6\u2010, 12\u2010, and 24\u2010month assessments. Analyses were descriptive and used variable\u2010specific denominators because follow\u2010up and laboratory data were incomplete at later time points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Biopsy data for cellular\u2010mediated rejection (CMR) were available in 19 patients through 12\u2009months and in 11 patients at 24\u2009months. The proportion with \u2265\u20091R CMR decreased from 11\/19 (57.9%) at baseline to 4\/19 (21.1%) at 3\u2009months, 3\/19 (15.8%) at 6\u2009months, 2\/19 (10.5%) at 12\u2009months, and 0\/11 at 24\u2009months. pAMR1 was present in 6\/18 (33.3%) patients with available baseline AMR data, absent at 3\u2009months, present in 1\/19 (5.3%) at 6\u2009months, and absent among patients with available biopsies at 12 and 24\u2009months. In contrast, Class II DSA positivity did not show a consistent decline (12\/19 [63.2%] at baseline and 8\/10 [80.0%] at 24\u2009months). Left ventricular systolic function remained broadly preserved among available observations, and corticosteroid dose decreased over time. Seven deaths occurred during the available overall follow\u2010up, four of which were recorded as reasons for ECP discontinuation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this small, retrospective, uncontrolled, and clinically heterogeneous cohort, ECP use was temporally associated with a lower biopsy\u2010documented rejection burden and reduced corticosteroid exposure. The study does not establish a causal effect of ECP on rejection, antibody burden, or safety, and the antibody data do not support a uniform reduction in DSA. Prospective multicentre studies with standardized treatment protocols, assay definitions, and complete longitudinal follow\u2010up are required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aor.70232","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:59:21Z","timestamp":1787720361000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Extracorporeal Photopheresis in Heart Transplantation: Mechanisms, Clinical Integration, and the Experience of the Azienda Ospedaliera Universitaria Senese"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7596-2963","authenticated-orcid":false,"given":"Luca","family":"Martini","sequence":"first","affiliation":[{"name":"Cardiology Unit, Heart\u2010Chest\u2010Vessel Department Azienda Ospedaliera Universitaria Senese  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca 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of Medical, Surgical, and Neurological Sciences University of Siena  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serafina","family":"Valente","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Heart\u2010Chest\u2010Vessel Department Azienda Ospedaliera Universitaria Senese  Siena Italy"},{"name":"Division of Cardiology, Department of Medical Biotechnologies University of Siena  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Maccherini","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Heart\u2010Chest\u2010Vessel Department Azienda Ospedaliera Universitaria Senese  Siena 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