title: Failure of bortezomib to cure acute antibody-mediated rejection in a non-compliant renal transplant patient.
abstract: Bortezomib has appeared recently as a potential active treatment for acute AMR for few years. We reported a patient who received two courses of bortezomib for the treatment of an acute AMR associated with de novo HLA DSA that occurred 18 months after renal transplantation because of non-compliance. Graft biopsy revealed features of acute humoral rejection with plasmocyte infiltration and C4d staining. Bortezomib was associated with corticosteroid pulses, IVIgs, and PP. Despite this rapid management, the patient lost his graft and carried on dialysis. Bortezomib therapy in addition to current therapy of AMR is not always effective in the treatment for late acute AMR in renal transplantation. We discuss on the place of such a treatment and other therapeutic strategies in this indication.
authors.affiliation: Pediatric Department, Centre Hospitalier et Universitaire, Rennes, France.
authors.forename: A
authors.initials: A
authors.lastname: Ryckewaert
authors.forename: E
authors.initials: E
authors.lastname: Allain-Launay
authors.forename: A
authors.initials: A
authors.lastname: Moreau
authors.forename: G
authors.initials: G
authors.lastname: Blancho
authors.forename: A
authors.initials: A
authors.lastname: Cesbron
authors.forename: N
authors.initials: N
authors.lastname: Blin
authors.forename: G
authors.initials: G
authors.lastname: Roussey
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000906:Antibodies / Q000737:chemistry*; D001706:Biopsy; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D015935:Complement C4b / Q000737:chemistry; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000737:chemistry; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D010349:Patient Compliance; D010446:Peptide Fragments / Q000737:chemistry; D017044:Polycystic Kidney, Autosomal Recessive / Q000628:therapy*; D011480:Protease Inhibitors / Q000627:therapeutic use; D011719:Pyrazines / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000906:Antibodies; D001897:Boronic Acids; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D010446:Peptide Fragments; D011480:Protease Inhibitors; D011719:Pyrazines; D000069286:Bortezomib; D015935:Complement C4b; C032261:complement C4d
keywords: antibody-mediated rejection; bortezomib; renal transplantation