title: Outcomes of combination therapy for chronic antibody-mediated rejection in renal transplantation.
abstract: OBJECTIVE
  Chronic antibody-mediated rejection (CAMR) in renal transplant patients has poor allograft outcomes. However, treatment strategy has not been established yet. Herein, we present short-term outcomes of combination therapy for CAMR.
  
  
  METHODS
  We identified nine patients with CAMR or suspicious CAMR who were treated with antihumoral therapy from 2010 to 2011 and analyzed their medical records retrospectively.
  
  
  RESULTS
  Five patients had CAMR, and four patients had suspicious CAMR. Severe transplant glomerulopathy (TG) was observed in seven patients. The estimated glomerular filtration rate (eGFR) was decreased in all patients before treatment. We used three different treatment regimens: (i) high-dose intravenous immunoglobulin (IVIG) and rituximab; (ii) high-dose IVIG, rituximab, and bortezomib; and (iii) plasmapheresis with low-dose IVIG, rituximab and bortezomib. After treatment with one of these three regimens, graft function improved or stabilized in six patients, whereas three patients showed further deterioration of eGFR. The third regimen suppressed deterioration of renal function in all patients. Most patients showed no progression of proteinuria. Infectious complications due to Pneumocystis jirovecii pneumonia and herpes zoster occurred in two patients.
  
  
  CONCLUSIONS
  Combination therapy for CAMR might be effective, even in patients with relatively late-stage CAMR.
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea; Transplantation Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Myung-Gyu
authors.initials: MG
authors.lastname: Kim
authors.forename: Yoon Jung
authors.initials: YJ
authors.lastname: Kim
authors.forename: Hyuk Yong
authors.initials: HY
authors.lastname: Kwon
authors.forename: Hayne Cho
authors.initials: HC
authors.lastname: Park
authors.forename: Tai Yeon
authors.initials: TY
authors.lastname: Koo
authors.forename: Jong Cheol
authors.initials: JC
authors.lastname: Jeong
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Jeon
authors.forename: Miyeun
authors.initials: M
authors.lastname: Han
authors.forename: Curie
authors.initials: C
authors.lastname: Ahn
authors.forename: Jaeseok
authors.initials: J
authors.lastname: Yang
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D002908:Chronic Disease; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000628:therapy*; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011719:Pyrazines / Q000627:therapeutic use; D012189:Retrospective Studies; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D001897:Boronic Acids; D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies; D011719:Pyrazines; D000069283:Rituximab; D000069286:Bortezomib
keywords: bortezomib; chronic antibody-mediated rejection; immunoglobulin; plasmapheresis; rituximab