title: High immunologic risk living donor kidney transplant using bortezomib in a novel induction regimen without acute antibody mediated rejection.
abstract: Desensitization therapies have been used with modest success in kidney transplantation. Some candidates, however, have such great breadth and depth of anti-HLA antibodies that they remain incompatible with potential donors. Bortezomib has been used without much success in desensitization regimens, but we hypothesized that its use during induction may be helpful in targeting antibody production by long-lived plasma cells. This report describes a high-risk positive crossmatch son-to-mother transplant that was performed after desensitization. The induction immunosuppression was supplemented with bortezomib. Pre- and post-transplant immunosuppression, antibody monitoring, biopsy data, and the clinical course are described in detail. Following transplant, the patient had excellent early graft function. Serial biopsies did not reveal acute antibody mediated rejection. Despite excellent graft function, the patient underwent withdrawal of care and died due to complications of calciphylaxis and deconditioning. This case details the first report of bortezomib used as part of induction therapy in solid organ transplant. Donor specific antibody production remained stable after transplant, with near complete abrogation of class I specificities. There were no bortezomib-related complications.
authors: Divisions of Transplant Surgery, University of Minnesota, Minneapolis, Minnesota, USA. dunn0017@umn.edu
authors: Ty B
authors: TB
authors: Dunn
authors: Daniel
authors: D
authors: Borja-Cacho
authors: Srinath
authors: S
authors: Chinnakotla
authors: Erik
authors: E
authors: Finger
authors: Gerardo
authors: G
authors: Tamayo
authors: Priya
authors: P
authors: Verghese
authors: Youngki
authors: Y
authors: Kim
authors: Carlos
authors: C
authors: Manivel
authors: Raja
authors: R
authors: Kandaswamy
authors: Arthur
authors: A
authors: Matas
authors: Timothy
authors: T
authors: Pruett
authors: Harriet
authors: H
authors: Noreen
authors: Peggy
authors: P
authors: Krefting
authors: David
authors: D
authors: Maurer
mesh_terms: D000328:Adult; D001706:Biopsy; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D003888:Desensitization, Immunologic; D017809:Fatal Outcome; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006680:HLA Antigens / Q000276:immunology; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007518:Isoantibodies / Q000097:blood; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D019520:Living Donors; D008297:Male; D015166:Monitoring, Immunologic; D010690:Phlebography / Q000379:methods; D011719:Pyrazines / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D001897:Boronic Acids; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D011719:Pyrazines; D000069286:Bortezomib