J Korean Soc Transplant.  2014 Jun;28(2):87-90. 10.4285/jkstn.2014.28.2.87.

Treatment of Refractory Antibody-mediated Rejection with Bortezomib in a Kidney Transplant Recipient: A Case Report

• Lee JY
• Yoo JY
• Kwon SH
• Jeon JS
• Noh H
• Han DC
• Song D
• Jin SY

• KMID: 2202536
• DOI: http://doi.org/10.4285/jkstn.2014.28.2.87

Abstract

Antibody-mediated rejection (ABMR) is associated with poor renal allograft survival. It shows poor response to conventional treatment with plasmapheresis, rituximab, and intravenous immunoglobulin. Bortezomib, a proteasome inhibitor used for treatment of multiple myeloma, has recently been reported as a treatment alternative for recipient desensitization and ABMR. A 58-year-old man was diagnosed with mixed-type ABMR with donor specific antibodies and acute T cell-mediated rejection early after kidney transplantation. Conventional therapy was administered, including antithymocyte globulin, plasmapheresis, and rituximab; however, his condition was found to be refractory to these antihumoral therapies. Following administration of bortezomib, his serum creatinine level returned to baseline with stable graft function. His serum creatinine level remains stable at 1.3 mg/dL at 10 months posttransplantation. Bortezomib is effective for treatment of refractory ABMR following kidney transplantation.

Keyword

Proteasome inhibitors; Antibody-mediated rejection; Kidney transplantation

MeSH Terms

Allografts
Antibodies
Antilymphocyte Serum
Bortezomib
Creatinine
Humans
Immunoglobulins
Kidney Transplantation
Kidney*
Middle Aged
Multiple Myeloma
Plasmapheresis
Proteasome Inhibitors
Rituximab
Tissue Donors
Transplantation*
Transplants
Antibodies
Antilymphocyte Serum
Creatinine
Immunoglobulins
Proteasome Inhibitors

Figure

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  Fig. 1. There is evidence of mixed interstitial infiltration with neutrophils and lymphocytes (PAS, ×400).

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  Fig. 2. Prebortezomib graft biopsy shows mixed type of acute antibody-mediated rejection and acute cellular rejection (PAS,×100).

Reference

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