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Around 25% of organ transplant recipients encounter acute rejection within the initial year post-transplantation. Acute rejection is further categorized into cellular (ACR) and antibody-mediated (AMR) forms. Over the long term, the threat shifts to chronic rejection, posing a risk to graft function and patient survival. Finding a balance between the beneficial and adverse effects of immunosuppression in preventing or treating rejection is challenging . Factors such as opportunistic infections and malignancies contribute to this challenge. Consequently, there is a keen interest in therapies that can effectively modulate alloimmune responses without suppressing immune responses to infection or malignancy. Extracorporeal Photopheresis (ECP) presents a potential for this approach in organ transplantation yet its precise mechanism of action is still to be determined. Learning Objectives: To provide an overview of the role of ECP in solid organ transplantation and why understanding its MoA is important clinically. To review the latest understanding on its MoA and how this is being used to treat transplant recipients in different clinical scenarios. Moderatore: Luciano Potena. Teresa Rampino Organizzatori presenti: Cristiano Amarelli (Napoli) Massimo Maccherini (Siena) Federica Meloni (Padova) Luciano Potena (Bologna) Teresa Rampino (Pavia) ESOT: https://www.esot.org