title: 1.7 year follow-up after bortezomib therapy for refractory antibody mediated rejection.
abstract: In summary, 1.7 years after transplantation, bortezomib rescue has been durably effective in salvaging our patient with refractory antibody mediated rejection. The only price has been persistently high levels of BK viruria. The presence of ongoing and even recurrent donor specific antibody has made it difficult to reduce immunosuppression further, and the concern that the high levels of BK viruria will eventually progress to viremia and nephropathy necessitates continued therapy with very low dose cidofovir and leflunomide. The absence of C1q binding DSA with stable renal function may provide some reserved optimism that the DSA that is detectable by convention Luminex assay may have reduced pathological implications. However, more data and prolonged follow-up are needed to determine whether or not non-complement binding DSA has an adverse pathological role.
authors.affiliation: Univ of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA.
authors.forename: R
authors.initials: R
authors.lastname: Shapiro
authors.forename: J
authors.initials: J
authors.lastname: Lunz
authors.forename: A
authors.initials: A
authors.lastname: Zeevi
authors.forename: A
authors.initials: A
authors.lastname: Basu
authors.forename: M
authors.initials: M
authors.lastname: Mapara
authors.forename: P
authors.initials: P
authors.lastname: Randhawa
authors.forename: H P
authors.initials: HP
authors.lastname: Tan
authors.forename: V
authors.initials: V
authors.lastname: Sharma
authors.forename: A
authors.initials: A
authors.lastname: Humar
mesh_terms: D001739:BK Virus / Q000472:pathogenicity; D001897:Boronic Acids / Q000009:adverse effects / Q000627:therapeutic use*; D000069286:Bortezomib; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D056724:Immunity, Humoral / Q000187:drug effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000276:immunology*; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000821:virology; D011480:Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D046988:Proteasome Endopeptidase Complex / Q000378:metabolism; D061988:Proteasome Inhibitors; D011719:Pyrazines / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001897:Boronic Acids; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D011480:Protease Inhibitors; D061988:Proteasome Inhibitors; D011719:Pyrazines; D000069286:Bortezomib; D046988:Proteasome Endopeptidase Complex