Successful treatment with bortezomib of a refractory humoral rejection of the intestine after multivisceral transplantation.
Graft rejection is a serious complication after intestinal and multivisceral transplantation. Classic anti-rejection strategies often focus on addressing the cellular component, however mounting evidence suggests that antibody mediated rejection may also play an important role in patient and graft survival. Bortezomib, a proteasome inhibitor used in the treatment of multiple myeloma, has been found to be useful in treating antibody mediated rejection in kidney transplant recipients. The following case illustrates how bortezomib was used to successfully reverse refractory rejection in a patient following multivisceral transplantation. While the rejection was able to be controlled, this patient's course was complicated by an aggressive viral infection after bortezomib therapy. Bortezomib may be a useful agent in the treatment of rejection after intestinal and multivisceral transplantation; however more data is needed to assess its impact on infectious complications in this complex group of patients.
Island
Eddie R
ER
Department of Surgery, University of Miami School of Medicine, Miami, Florida, USA.
Gonzalez-Pinto
Ignacio M
IM
Tsai
Hin-Lin
HL
Ruiz
Phillip
P
Tryphonopoulos
Panagiotis
P
Gonzalez
Monica L
ML
Solano
Juan P
JP
Rossique
Marie
M
Selvaggi
Gennaro
G
Tekin
Akin
A
Smith
Lesley J
LJ
Tzakis
Andreas G
AG
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001706:Biopsy; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000473:pathology; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007422:Intestines / Q000187:drug effects / Q000276:immunology* / Q000473:pathology; D011480:Protease Inhibitors / Q000627:therapeutic use*; D011719:Pyrazines / Q000627:therapeutic use*; D012778:Short Bowel Syndrome / Q000601:surgery*; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome; D014781:Viscera / Q000637:transplantation*
D000305:Adrenal Cortex Hormones; D000961:Antilymphocyte Serum; D001897:Boronic Acids; D007166:Immunosuppressive Agents; D011480:Protease Inhibitors; D011719:Pyrazines; D000069286:Bortezomib; D016559:Tacrolimus