J Korean Med Sci.  2014 May;29(5):648-651. 10.3346/jkms.2014.29.5.648.

Use of Bortezomib as Anti-Humoral Therapy in Kidney Transplantation

• Yang KS
• Jeon H
• Park Y
• Jo IH
• Kim JI
• Moon IS
• Choi BS
• Park CW
• Yang CW
• Kim YS
• Chung BH

• KMID: 1786104
• DOI: http://doi.org/10.3346/jkms.2014.29.5.648

Abstract

This study aimed to investigate the effect of bortezomib in the desensitization and treatment of acute antibody mediated rejection (AAMR) in kidney transplantation. Nine patients who received bortezomib therapy for desensitization (DSZ group, n = 3) or treatment of AAMR (AAMR group, n = 6) were included in this study. In the DSZ group, 2 patients required DSZ owing to positive cross match and 1 owing to ABO mismatch with high baseline anti-ABO antibody titer (1:1,024). Bortezomib was used at 1, 3, 8, and 11 days from the start of the treatment. In the AAMR group, 3 patients showed full recovery of allograft function after bortezomib use and decrease in donor specific anti-HLA antibody (HLA-DSA). However, 3 patients did not respond to bortezomib and experienced allograft failure. In the DSZ group, negative conversion of T-CDC (complement-dependent cytotoxicity) was achieved, and HLA-DSA was decreased to lower than a weak level (median fluorescence intensity [MFI] < 5,000) in 2 patients. In the case of ABO mismatch kidney transplantation, the anti-A/B antibody titer decreased to below the target (< or = 1:16) after bortezomib therapy. Therefore, bortezomib could be an alternative therapeutic option for desensitization and treatment of AAMR that is unresponsive to conventional therapies.

Keyword

Kidney Transplantation; Bortezomib; Anti-Humoral Therapy; Desensitization; Antibody Mediated Rejection

MeSH Terms

Adult
Boronic Acids/*therapeutic use
Desensitization, Immunologic/*methods
Female
Graft Rejection/*drug therapy/*prevention & control
HLA Antigens/immunology
Humans
Kidney/surgery
Kidney Transplantation/*methods
Male
Middle Aged
Pyrazines/*therapeutic use
Treatment Outcome
Boronic Acids
HLA Antigens
Pyrazines

Figure

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  Fig. 1 The clinical course of AMR group. (A) patient A, (B) patient B, (C) patient C, (D) patient D, (E) patient E, (F) patient F. AMR, antibody mediated rejection; PP, plasmapheresis; IVIG, intravenous immune globulin.

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