title: Bortezomib is effective to treat acute humoral rejection after liver transplantation.
abstract: BACKGROUND
  Acute humoral rejection (AHR), a rare complication in orthotopic liver transplantation (OLT), responds poorly to conventional therapies. Bortezomib, a proteasome inhibitor, has been shown to be effective in treating plasma cell-derived tumors and acute rejection episodes after renal transplantation. Herein, we have reported our clinical experience with bortezomib as a novel approach to treat AHR after OLT.
  
  
  METHODS
  We retrospectively analyzed the 247 adult OLTs performed from January 2007 to April 2011. Patients with AHR who were treated with steroid pulses, rituximab (375 mg/m2), and plasmapheresis (PP) were assigned to group A. Group B subjects were prescribed steroid pulses, rituximab, PP, and bortezomib (1.3 mg/m2), after March 2009.
  
  
  RESULTS
  Among the 9 patients (3.6%) diagnosed with AHR, all subjects in group A (n=3) died within several days after AHR, whereas 4/6 (66.7%) group B patients were rescued and 3 (50%) survived at a mean follow-up 22.3 months (range, 18-26).
  
  
  CONCLUSIONS
  Proteasome inhibitor-based therapies provide a more effective strategy to treat AHR after OLT.
authors.affiliation: Chang-Gung Transplantation Institute, Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, Chang-Gung University Medical School, Taoyuan, Taiwan.
authors.forename: C-F
authors.initials: CF
authors.lastname: Lee
authors.forename: F Z
authors.initials: FZ
authors.lastname: Eldeen
authors.forename: K-M
authors.initials: KM
authors.lastname: Chan
authors.forename: T-H
authors.initials: TH
authors.lastname: Wu
authors.forename: R-S
authors.initials: RS
authors.lastname: Soong
authors.forename: T-J
authors.initials: TJ
authors.lastname: Wu
authors.forename: H-S
authors.initials: HS
authors.lastname: Chou
authors.forename: W-C
authors.initials: WC
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000201:enzymology / Q000276:immunology / Q000401:mortality; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D056724:Immunity, Humoral / Q000187:drug effects*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011480:Protease Inhibitors / Q000627:therapeutic use*; D046988:Proteasome Endopeptidase Complex / Q000187:drug effects / Q000378:metabolism; D020551:Pulse Therapy, Drug; D011719:Pyrazines / Q000627:therapeutic use*; D012189:Retrospective Studies; D000069283:Rituximab; D013256:Steroids / Q000008:administration & dosage; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D001897:Boronic Acids; D007166:Immunosuppressive Agents; D011480:Protease Inhibitors; D011719:Pyrazines; D013256:Steroids; D000069283:Rituximab; D000069286:Bortezomib; D046988:Proteasome Endopeptidase Complex