title: The use of bortezomib as a rescue treatment for acute antibody-mediated rejection: report of three cases and review of literature.
abstract: Antibody-mediated rejection (AMR) typically occurs early after transplantation in approximately 5%-7% of recipients. The literature reports suggest that 12%-37% of kidney transplant recipients with acute AMR do not respond to treatment and eventually lose their grafts. The proteasome inhibitor bortezomib is currently approved by the Food and Drug Administration for the treatment of multiple myeloma. It has been demonstrated both in vitro and in vivo to possess apoptotic properties against mature plasma cells. Herein we have described a series of 3 patients with positive cross-matches who developed early AMR after kidney transplantation. Bortezomib rescue treatment was administered after the patients failed to respond to plasmapheresis/intravenous immunoglobulin and splenectomy. All 3 patients responded with full, durable recovery of renal function. In conclusion, bortezomib is useful to treat refractory AMR after kidney transplantation.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: I
authors.initials: I
authors.lastname: Tzvetanov
authors.forename: M
authors.initials: M
authors.lastname: Spaggiari
authors.forename: J
authors.initials: J
authors.lastname: Joseph
authors.forename: H
authors.initials: H
authors.lastname: Jeon
authors.forename: J
authors.initials: J
authors.lastname: Thielke
authors.forename: J
authors.initials: J
authors.lastname: Oberholzer
authors.forename: E
authors.initials: E
authors.lastname: Benedetti
mesh_terms: D000208:Acute Disease; D000328:Adult; D001897:Boronic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D000069286:Bortezomib; D057915:Drug Substitution; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D006085:Graft Survival / Q000187:drug effects; D006680:HLA Antigens / Q000276:immunology; D006648:Histocompatibility; D006801:Humans; D056724:Immunity, Humoral / Q000187:drug effects*; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007518:Isoantibodies / Q000097:blood; D007668:Kidney / Q000187:drug effects / Q000276:immunology / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011719:Pyrazines / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001897:Boronic Acids; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D011719:Pyrazines; D000069286:Bortezomib