title: Use of bortezomib to treat anti-HLA antibodies in renal transplant patients: a single-center experience.
abstract: Donor-specific human leukocyte antigen (HLA) antibodies (DSA) are associated with decreased graft survival and may cause graft rejection. Bortezomib, a selective inhibitor of the 26S proteasome developed to treat multiple myeloma, has been used for its anti-plasma cell activity in patients undergoing transplantation. We describe our experience with bortezomib used to reduce anti-HLA antibodies in eight renal transplant patients. Patients received bortezomib (1.3mg/m(2)) on days 1, 4, 8, and 11 beginning when antibodies were detected. It was used alone in one patient and was complemented with plasmapheresis in five patients, with IVIG in one patient, and with IVIG and plasmapheresis in another patient. De novo DSA class II were detected in all eight patients and two also had DSA class I. Antibodies were entirely eliminated in five (62.5%) patients 90 days after treatment but only reduced in the other three (62.5%). Notably, they later increased in one patient. Five (62.5%) patients had AMR, two (25%) had mixed rejection, and one had no rejection. our results suggest that bortezomib is effective for reducing DSA avoiding chronic graft injury.
authors.affiliation: Renal Transplantation, Hospital Alemán, Pueyrredón 1640, C1118AAT Buenos Aires, Argentina; Foundation for Research and Assistance in Renal Disease (FINAER), 503 No. 1947, B1897FYU Gonnet, La Plata, Buenos Aires, Argentina. Electronic address: fcicora5@gmail.com.
authors.forename: Federico
authors.initials: F
authors.lastname: Cicora
authors.forename: Marta
authors.initials: M
authors.lastname: Paz
authors.forename: Fernando
authors.initials: F
authors.lastname: Mos
authors.forename: Javier
authors.initials: J
authors.lastname: Roberti
mesh_terms: D000328:Adult; D064591:Allografts; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001323:Autoantibodies / Q000097:blood*; D001897:Boronic Acids / Q000008:administration & dosage*; D000069286:Bortezomib; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011719:Pyrazines / Q000008:administration & dosage*
chemical_list: D000970:Antineoplastic Agents; D001323:Autoantibodies; D001897:Boronic Acids; D016756:Immunoglobulins, Intravenous; D011719:Pyrazines; D000069286:Bortezomib
keywords: Alloantibody; Bortezomib; HLA; Kidney; Proteasome inhibitor; Transplantation