Journal List > J Korean Soc Transplant > v.32(3) > 1101757

J Korean Soc Transplant. 2018 Sep;32(3):49-56. Korean.
Published online September 27, 2018.  https://doi.org/10.4285/jkstn.2018.32.3.49
Copyright © the Korean Society for Transplantation, 2018
The Effect of Bortezomib on the Management of Immediate Postoperative Refractory Antibody-Mediated Rejection after Kidney Transplantation
So-Jeong Kim, M.D.,1 Kang-Woong Jun, M.D.,1 Jeong-Kye Hwang, M.D.,1 Byung-Ha Chung, M.D.,2 Chul-Woo Yang, M.D.,2 In-Sung Moon, M.D.,1 Ji-il Kim, M.D.,1 and Mi-Hyeong Kim, M.D.1
1Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
2Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Corresponding author: Mi-Hyeong Kim. Division of Vascular and Transplant Surgery, Department of Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, 180 Wangsan-ro, Dongdaemun-gu, Seoul 02559, Korea. Tel: 82-2-961-4529, Fax: 82-2-960-4568, Email: mhkim@catholic.ac.kr
Received March 30, 2018; Revised June 10, 2018; Accepted July 05, 2018.

Abstract

Background

Bortezomib has been used to treat antibody-mediated rejection (AMR) that usually develops after kidney transplantation (KT). Although it has been used in various clinical situations, it is difficult to precisely define how the drug affects the clinical course. We used bortezomib to treat eight cases of AMR that developed immediately following KT in patients who were resistant to conventional treatment.

Methods

Eight cases of refractory AMR that developed immediately after KT were treated with bortezomib on days 1, 4, 8, and 11.

Results

The resolution rate was 75%, and the 2-year rejection-free survival rate was 83%. Six cases underwent immunologically high-risk KT. Six recovering patients exhibited clinical improvement within 2 weeks of the first dose of bortezomib and recovered completely within 2 months. The effects of bortezomib seemed to be prolonged; only one additional rejection episode was observed. The two failed patients never exhibited any clinical improvement and progressed aggressively to graft failure soon after transplantation. Their donor specific anti-human leukocyte antigen antibody were sustained at high levels.

Conclusions

Bortezomib is an effective rescue therapy in patients with AMR that developed immediately after KT.

Keywords: Bortezomib; Graft rejection; Immunosuppression; Kidney transplantation

Figures


Fig. 1
Serum creatinine changes after bortezomib treatment of the six patients who recovered. Serum creatinine levels began to decrease within 2 weeks of bortezomib treatment, and recovery was achieved within 2 months.
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Tables


Table 1
Preoperative patient characteristics
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Table 2
Changes in donor-specific antibody levels during the peri-transplantation period
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Table 3
Treatments for transplant recipients exhibiting antibody-mediated rejection
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Table 4
Pathological features of graft biopsies of transplant recipients exhibiting antibody-mediated rejection
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