title: Bortezomib in ABO-incompatible kidney transplant desensitization: a case report.
abstract: Positive B cell crossmatch accompanied by high levels of pre-transplant human leukocyte antigen donor-specific antibodies are associated with adverse graft outcomes in kidney transplant recipients. Targeting plasma cells, the main antibody producing cells, with the proteasome inhibitor bortezomib may be a promising desensitization strategy. We report using a combination of bortezomib and plasmapheresis to desensitize a highly sensitized kidney transplant recipient for an ABO-incompatible living donor kidney transplant. The flow cytometric B cell crossmatch was positive on presentation. After treatment, the anti-A titres fell from 1:64 to 1:4, and a negative B flow cytometric crossmatch was achieved prior to transplantation. The combined approach of bortezomib to abrogate antibody production at the plasma cell level, followed by plasmapheresis and low-dose intravenous immunoglobulin to remove in-circulation alloantibodies, has proven to be effective in our case. Bortezomib may play a role in highly sensitized renal transplants.
authors: Centre for Transplant and Renal Research, Westmead Hospital.
authors: Nikki L
authors: NL
authors: Wong
authors: Philip
authors: P
authors: O'Connell
authors: Jeremy R
authors: JR
authors: Chapman
authors: Brian
authors: B
authors: Nankivell
authors: Kathy
authors: K
authors: Kable
authors: A C
authors: AC
authors: Webster
authors: Germaine
authors: G
authors: Wong
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000069286:Bortezomib / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003888:Desensitization, Immunologic / Q000379:methods*; D005434:Flow Cytometry; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006648:Histocompatibility / Q000187:drug effects*; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D010956:Plasmapheresis; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D000069286:Bortezomib
keywords: ABO incompatible; bortezomib; desensitization; kidney transplant