title: Case Report: Successful Living Donor Kidney Transplantation in a Highly Human Leukocyte Antigen-Sensitized Recipient With a Positive Cytotoxic Crossmatch Using Bortezomib-Based Desensitization Without Intravenous Immunoglobulin.
abstract: BACKGROUND
  Highly sensitized patients, who produce antibodies against multiple anti-human leukocyte antigens, have significantly reduced chances for renal transplantation. Traditionally, desensitization protocols to reduce the levels of antibodies have relied on the use of intravenous immunoglobulin and plasmapheresis.
  
  
  RESULTS
  Here we report the case of a patient with a calculated panel-reactive antibody level of 100% who was desensitized using multiple courses of bortezomib, a proteasome inhibitor, in an intravenous immunoglobulin-free regimen. The patient underwent a successful transplantation with an allograft from a living donor and has continued to do well post-transplantation.
  
  
  CONCLUSIONS
  The expression of anti-human leukocyte antigen antibodies decreases the likelihood of transplantation for patients by restricting the available donor pool. New protocols that reduce antibody expression in these patients and allow for renal transplantation are needed. Bortezomib, as used in the patient reported here, represents a promising new medication for successful desensitization and transplantation.
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA; Department of Pharmacy Services, B-069, Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: J Y
authors.initials: JY
authors.lastname: Revollo
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Cuffy
authors.affiliation: Division of Nephrology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: B G
authors.initials: BG
authors.lastname: Abu Jawdeh
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: F
authors.initials: F
authors.lastname: Paterno
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA; Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA.
authors.forename: A
authors.initials: A
authors.lastname: Girnita
authors.affiliation: Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA.
authors.forename: P
authors.initials: P
authors.lastname: Brailey
authors.affiliation: Division of Nephrology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: R R
authors.initials: RR
authors.lastname: Alloway
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA. Electronic address: woodlees@uc.edu.
authors.forename: E S
authors.initials: ES
authors.lastname: Woodle
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D001788:Blood Grouping and Crossmatching; D000069286:Bortezomib / Q000627:therapeutic use*; D003888:Desensitization, Immunologic / Q000379:methods*; D006084:Graft Rejection / Q000276:immunology / Q000628:therapy*; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis
chemical_list: D000970:Antineoplastic Agents; D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies; D000069286:Bortezomib