title: Effective therapy for acute antibody-mediated rejection with mild chronic changes: case report and review of the literature.
abstract: To reduce the long-term toxicities of immunosuppressant drugs, corticosteroid-sparing and calcineurin-inhibitor-sparing immunosuppression protocols have become increasingly popular in managing kidney transplant recipients. The most vexing clinical condition caused by antibodies in organ transplants is antibody-mediated rejection. Limitations of the current antibody-mediated rejection therapies include (1) antibody-mediated rejection reversal tends to be gradual rather than prompt, (2) expense, (3) rejection reversal rates below 80%, (4) common appearance of chronic rejection after antibody-mediated rejection treatment, and (5) long-term persistence of donor specific antibodies after therapy. Because these limitations may be due to a lack of effects on mature plasma cells, the effects of bortezomib on mature plasma cells may represent a quantum advance in antihumoral therapy.  Our experiences represent the first clinical use of bortezomib as an antihumoral agent in renal allograft recipients in Kuwait. We present 2 cases with resistant-acute antibody-mediated rejection to the standard therapies that were managed successfully with bortezomib.
authors: Department of Nephrology, Hamed Al-Essa Organ Transplant Center, Kuwait. ogheith@yahoo.com
authors: Osama
authors: O
authors: Gheith
authors: Torki
authors: T
authors: Al-Otaibi
authors: Narayanan
authors: N
authors: Nampoory
authors: Medhat
authors: M
authors: Halim
authors: Prasad
authors: P
authors: Nair
authors: Tarek
authors: T
authors: Saied
authors: Salah
authors: S
authors: Al-Waheeb
authors: Ibraheem
authors: I
authors: Muzeirei
authors: Mona
authors: M
authors: Ibraheim
mesh_terms: D000328:Adult; D000906:Antibodies / Q000097:blood; D001706:Biopsy; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D006801:Humans; D056724:Immunity, Humoral / Q000187:drug effects*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D011719:Pyrazines / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000906:Antibodies; D001897:Boronic Acids; D007166:Immunosuppressive Agents; D011719:Pyrazines; D000069286:Bortezomib