title: Successful treatment of severe acute antibody-mediated rejection of renal allografts with bortezomib--a report of two pediatric cases.
abstract: aAMR in renal allografts is uncommon and remains a challenge as it is often refractory to treatment modalities. Aggressive therapy is essential to reverse the rejection as it results in renal allograft loss in approximately 27-40% of cases. There are anecdotal case reports of use of bortezomib, a proteasome inhibitor in the treatment of resistant AMR cases in solid organ transplant recipients; however, the experience is limited. We herein report successful reversal of resistant aAMR in two pediatric patients with bortezomib. Patients were initially treated with IV methylprednisolone pulse therapy with IVIG and PP three times weekly for a total of 10 treatments. After the standard therapy used at our institution persistence of DSA associated with graft dysfunction prompted the use of bortezomib to further treat the rejection. We did not have any neurologic side effects, but one patient did experience significant infections after bortezomib infusions requiring prolonged antimicrobial therapy. The long-term outcome of both children was excellent with preservation of normal renal function and persistent reduction in DSA titers.
authors.affiliation: Barnabas Health Children's Kidney Center, Saint Barnabas Medical Center, Livingston, NJ, USA.
authors.forename: Isabel
authors.initials: I
authors.lastname: Roberti
authors.affiliation: Barnabas Health Children's Kidney Center, Saint Barnabas Medical Center, Livingston, NJ, USA.
authors.forename: Shefali
authors.initials: S
authors.lastname: Vyas
mesh_terms: D000293:Adolescent; D000069286:Bortezomib / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D061988:Proteasome Inhibitors / Q000627:therapeutic use*; D014184:Transplantation, Homologous
chemical_list: D061988:Proteasome Inhibitors; D000069286:Bortezomib
keywords: acute antibody-mediated rejection; bortezomib; children; kidney transplant