Effective therapy for acute antibody-mediated rejection with mild chronic changes: case report and review of the literature

Exp Clin Transplant. 2012 Aug;10(4):406-9. doi: 10.6002/ect.2011.0153. Epub 2012 Jun 29.

Abstract

To reduce the long-term toxicities of immunosuppressant drugs, corticosteroid-sparing and calcineurin-inhibitor-sparing immunosuppression protocols have become increasingly popular in managing kidney transplant recipients. The most vexing clinical condition caused by antibodies in organ transplants is antibody-mediated rejection. Limitations of the current antibody-mediated rejection therapies include (1) antibody-mediated rejection reversal tends to be gradual rather than prompt, (2) expense, (3) rejection reversal rates below 80%, (4) common appearance of chronic rejection after antibody-mediated rejection treatment, and (5) long-term persistence of donor specific antibodies after therapy. Because these limitations may be due to a lack of effects on mature plasma cells, the effects of bortezomib on mature plasma cells may represent a quantum advance in antihumoral therapy. Our experiences represent the first clinical use of bortezomib as an antihumoral agent in renal allograft recipients in Kuwait. We present 2 cases with resistant-acute antibody-mediated rejection to the standard therapies that were managed successfully with bortezomib.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Antibodies / blood
  • Biopsy
  • Boronic Acids / therapeutic use*
  • Bortezomib
  • Chronic Disease
  • Drug Therapy, Combination
  • Female
  • Graft Rejection / drug therapy*
  • Graft Rejection / immunology
  • Graft Rejection / pathology
  • Humans
  • Immunity, Humoral / drug effects*
  • Immunosuppressive Agents / therapeutic use*
  • Kidney / drug effects*
  • Kidney / immunology
  • Kidney / pathology
  • Kidney Transplantation / immunology*
  • Male
  • Pyrazines / therapeutic use*
  • Time Factors
  • Treatment Outcome
  • Young Adult

Substances

  • Antibodies
  • Boronic Acids
  • Immunosuppressive Agents
  • Pyrazines
  • Bortezomib