title: Bortezomib as the sole post-renal transplantation desensitization agent does not decrease donor-specific anti-HLA antibodies.
abstract: Persistence of donor-specific anti-HLA antibodies (DSA) associated with antibody-mediated graft injuries following kidney transplantation predicts evolution toward chronic humoral rejection and reduced graft survival. Targeting plasma cells, the main antibody-producing cells, with the proteasome inhibitor bortezomib may be a promising desensitization strategy. We evaluated the in vivo efficacy of one cycle of bortezomib (1.3 mg/m(2)x 4 doses), used as the sole desensitization therapy, in four renal transplant recipients experiencing subacute antibody-mediated rejection with persisting DSA (>2000 [Mean Fluorescence Intensity] MFI). Bortezomib treatment did not significantly decrease DSA MFI within the 150-day posttreatment period in any patient. In addition, antivirus (HBV, VZV and HSV) antibody levels remained stable following treatment suggesting a lack of efficacy on long-lived plasma cells. In conclusion, one cycle of bortezomib alone does not decrease DSA levels in sensitized kidney transplant recipients in the time period studied. These results underscore the need to evaluate this new desensitization agent properly in prospective, randomized and well-controlled studies.
authors.affiliation: Université Paris Descartes, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Sberro-Soussan
authors.forename: J
authors.initials: J
authors.lastname: Zuber
authors.forename: C
authors.initials: C
authors.lastname: Suberbielle-Boissel
authors.forename: S
authors.initials: S
authors.lastname: Candon
authors.forename: F
authors.initials: F
authors.lastname: Martinez
authors.forename: R
authors.initials: R
authors.lastname: Snanoudj
authors.forename: M
authors.initials: M
authors.lastname: Rabant
authors.forename: N
authors.initials: N
authors.lastname: Pallet
authors.forename: D
authors.initials: D
authors.lastname: Nochy
authors.forename: D
authors.initials: D
authors.lastname: Anglicheau
authors.forename: M
authors.initials: M
authors.lastname: Leruez
authors.forename: A
authors.initials: A
authors.lastname: Loupy
authors.forename: E
authors.initials: E
authors.lastname: Thervet
authors.forename: O
authors.initials: O
authors.lastname: Hermine
authors.forename: C
authors.initials: C
authors.lastname: Legendre
mesh_terms: D000328:Adult; D001706:Biopsy; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens / Q000096:biosynthesis* / Q000737:chemistry; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011719:Pyrazines / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001897:Boronic Acids; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D011719:Pyrazines; D000069286:Bortezomib