title: The Effect of Bortezomib on Antibody-Mediated Rejection after Kidney Transplantation.
abstract: OBJECTIVE
  Recently, bortezomib has been used to treat antibody-mediated rejection (AMR) refractory to conventional treatment such as plasmapheresis, intravenous immunoglobulin, and rituximab. The authors aimed to describe their experiences when bortezomib was used to treat refractory AMR.
  
  
  METHODS
  Eleven refractory AMR episodes treated with bortezomib were included in this study. The patients received one or two cycles of bortezomib (1.3 mg/m²) on days 1, 4, 8, and 11.
  
  
  RESULTS
  Bortezomib effectively reduced antibodies against various targets, including human leukocyte antigen (HLA) class I and II, ABO blood group antigen, and angiotensin II type 1 receptor. Antibodies were depleted or reduced significantly in eight AMR episodes. Overall, there was a significant improvement in the mean estimated glomerular filtration rate (eGFR) at 3 months after therapy (36.91±22.15 mL/min/1.73 m²) versus eGFR at time of AMR diagnosis (17.00±9.25 mL/min/1.73 m²; p=0.007). All six early-onset AMR episodes (within 6 months post-transplantation) showed full recovery of allograft function. Additionally, three of the five late-onset AMR episodes (>6 months post-transplantation) showed improved allograft function.
  
  
  CONCLUSIONS
  Anti-humoral treatment based on bortezomib might be an effective strategy against refractory AMR caused by various types of antibodies. Notably, this treatment could be more effective in early-onset AMR than in late-onset AMR.
authors.affiliation: The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.|Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Juhan
authors.initials: J
authors.lastname: Lee
authors.affiliation: The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.|Department of Internal Medicine (Nephrology), Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Beom Seok
authors.initials: BS
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yongjung
authors.initials: Y
authors.lastname: Park
authors.affiliation: The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.|Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jae Geun
authors.initials: JG
authors.lastname: Lee
authors.affiliation: Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Beom Jin
authors.initials: BJ
authors.lastname: Lim
authors.affiliation: Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyeon Joo
authors.initials: HJ
authors.lastname: Jeong
authors.affiliation: The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.|Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yu Seun
authors.initials: YS
authors.lastname: Kim
authors.affiliation: The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.|Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. khhuh@yuhs.ac.
authors.forename: Kyu Ha
authors.initials: KH
authors.lastname: Huh
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007518:Isoantibodies; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011719:Pyrazines / Q000008:administration & dosage; D014184:Transplantation, Homologous
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D001897:Boronic Acids; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007518:Isoantibodies; D011719:Pyrazines; D000069286:Bortezomib
keywords: Angiotensin II type 1 receptor antibodies; HLA antibodies; antibody-mediated rejection; bortezomib; kidney transplantation