title: Role of proteasome inhibition in sensitized transplant candidates.
abstract: OBJECTIVE
  To review this efficacy and safety of bortezomib, a proteasome inhibitor, in the setting of the sensitized transplant candidate.
  
  
  METHODS
  The data used in this review were from articles published (PubMed) between 2000 to 2010. Additionally abstracts from medical meetings related to transplant were also used.
  
  
  METHODS
  Articles were selected if they were trial results or case studies for the use of bortezomib in the sensitized patient population.
  
  
  RESULTS
  The early data using bortezomib as a part of desensitization regimens has shown success. Although one cycle (4 doses) of bortezomib seems to have affect on many patients, it also seems likely that to provide complete desensitization multiple cycles will be required. Regarding safety, bortezomib has been shown to have minimal side effects. The most common side effects reported are those of thrombocytopenia and anemia. These side effects are dose related and self limiting upon discontinuation of the treatment.
  
  
  CONCLUSIONS
  Bortezomib with plasmapheresis is a promising new alternative to desensitization protocols that use either high dose intravenous immune globulin (IVIG) or low dose IVIG and plasmapheresis. The efficacy on antibody reduction looks to be batter that that of the IVIG based regimens without significant addition toxicity. The results of ongoing prospective trials are positive and their complete results are greatly anticipated.
authors.affiliation: One Lambda Inc, Research 2 Division, Los Angeles, CA 90064, USA. meverly@onelambda.com
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Everly
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Everly
authors.forename: Paul I
authors.initials: PI
authors.lastname: Terasaki
mesh_terms: D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D011480:Protease Inhibitors / Q000627:therapeutic use*; D046988:Proteasome Endopeptidase Complex / Q000378:metabolism*; D011719:Pyrazines / Q000627:therapeutic use*; D019737:Transplants / Q000009:adverse effects
chemical_list: D001897:Boronic Acids; D011480:Protease Inhibitors; D011719:Pyrazines; D000069286:Bortezomib; D046988:Proteasome Endopeptidase Complex