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- Title
Treatment of acute antibody-mediated rejection using bortezomib: a case report.
- Authors
Sin, Yong‐Hun; Kim, Yong‐Jin; Oh, Joon Seok; Lee, Jin Ho; Kim, Seong Min; Kim, Joong Kyung
- Abstract
Here we report the successful treatment of acute antibody-mediated rejection ( AMR) with bortezomib. Bortezomib rescue treatment was administered after a 42-year-old woman failed to respond to steroid pulse and plasmapheresis with intravenous immunoglobulin ( IVIG). The patient underwent a second renal transplantation with a deceased donor kidney. She was treated pre-operatively with rituximab (200 mg/body) and underwent plasmapheresis twice (day-1 and operation day) because ELISA screening revealed that her pre-operative peak panel reactive antibody ( PRA) composition was 100% class I and 100% class II and 15 times of cross-match positive history during the waiting period for transplantation. The patients received induction therapy with Simulect (an IL-2-blocking agent). A 1-hour protocol biopsy revealed C4d-positivity and mild peritubular capillary inflammation. This was suggestive of early AMR-associated changes. After transplantation, the patient underwent plasmaphereses (nine times) with low-dose IVIG (2 mg/kg). Despite this treatment regimen, serum creatinine levels increased to 3.4 mg/dL on post-transplant day 15. A second graft biopsy was performed, which showed overt AMR with glomerulitis, peritubular capillary inflammation and no C4d deposition. On post-operative day ( POD) 22, treatment with four doses of bortezomib (1.3 mg/m2) was initiated with the patient's consent. On POD 55, renal function had recovered and serum creatinine was 1.5 mg/dL. In summary, bortezomib was administered as a rescue treatment for a patient who developed AMR that was refractory to a combination of plasmaphereses with low-dose IVIG and preemptive administration of rituximab.
- Subjects
GRAFT rejection; BORTEZOMIB; TREATMENT effectiveness; HEALTH outcome assessment; KIDNEY transplantation; INTRAVENOUS immunoglobulins
- Publication
Nephrology, 2015, Vol 20, p86
- ISSN
1320-5358
- Publication type
Article
- DOI
10.1111/nep.12459