Bortezomib for acute antibody-mediated rejection in liver transplantation.
Antibody-mediated rejection (AMR) is an uncommon, but challenging type of rejection after solid organ transplantation. We review three cases of AMR in ABO-compatible liver transplant recipients. These cases were characterized by severe acute rejection resistant to steroids and antithymocyte globulin, histologic evidence of plasma cell infiltrates, C4d positivity and high serum anti-HLA donor-specific antibodies. All three patients were treated with bortezomib, a proteasome inhibitor effective in depleting plasma cells. After treatment, all patients had improved or normal liver function tests, resolution of C4d deposition and significant decline in their HLA donor-specific antibodies.
Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, TX, USA.
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F
Paterno
M
M
Shiller
G
G
Tillery
J G
JG
O'Leary
B
B
Susskind
J
J
Trotter
G B
GB
Klintmalm
D000328:Adult; D000906:Antibodies / Q000276:immunology*; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011719:Pyrazines / Q000627:therapeutic use*; D012189:Retrospective Studies
D000906:Antibodies; D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib