title: Efficacy of bortezomib for reducing donor-specific antibodies in children and adolescents on a steroid minimization regimen.
abstract: AMR is increasingly being recognized as an important cause of renal allograft injury, contributing to significant morbidity and graft loss. There are few controlled trials and no well-established treatment guidelines for AMR in renal transplant recipients. We retrospectively reviewed the outcome of four pediatric renal transplant recipients on a steroid minimization immunosuppression protocol treated with bortezomib for elevated DSA and acute AMR from 2012 to 2013. All patients received four doses of bortezomib 1.3 mg/m2 given on days one, four, eight, and 11. All patients also received other treatments prior to bortezomib, which may have included rituximab, methylprednisolone, plasmapheresis, and/or IVIg. While bortezomib in addition to other therapies significantly decreased DSA titers, DSA remained very elevated months after treatment. All four patients had immediate improvement or stabilization of renal function but one eventually lost her graft. There were no adverse events related to bortezomib six months after treatment.
authors.affiliation: Department of Pediatrics, Section of Nephrology, University of California, Davis, Sacramento, CA, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nguyen
authors.forename: Brian
authors.initials: B
authors.lastname: Gallay
authors.forename: Lavjay
authors.initials: L
authors.lastname: Butani
mesh_terms: D000293:Adolescent; D000906:Antibodies / Q000097:blood*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D001897:Boronic Acids / Q000008:administration & dosage* / Q000627:therapeutic use; D000069286:Bortezomib; D002648:Child; D002675:Child, Preschool; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000276:immunology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007518:Isoantibodies / Q000276:immunology; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D010956:Plasmapheresis; D011719:Pyrazines / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D000069283:Rituximab; D013256:Steroids / Q000008:administration & dosage*; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000906:Antibodies; D058846:Antibodies, Monoclonal, Murine-Derived; D001897:Boronic Acids; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D011719:Pyrazines; D013256:Steroids; D000069283:Rituximab; D000069286:Bortezomib; D008775:Methylprednisolone
keywords: adolescent; antibody-mediated rejection; bortezomib; children; kidney transplantation