Efficacy and safety of BORTEZOMIB treatment for refractory acute antibody-mediated rejection-a pilot study
Language English Country Great Britain, England Media print
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
30168284
DOI
10.1111/tan.13387
Knihovny.cz E-resources
- Keywords
- Bortezomib, antibody-mediated rejection, donor-specific antibodies, intravenous immunoglobulins, plasmapheresis,
- MeSH
- Patient Safety MeSH
- Bortezomib therapeutic use MeSH
- Tissue Donors MeSH
- Adult MeSH
- HLA Antigens genetics immunology MeSH
- Transplantation, Homologous MeSH
- Adrenal Cortex Hormones therapeutic use MeSH
- Immunologic Factors therapeutic use MeSH
- Isoantibodies blood MeSH
- Middle Aged MeSH
- Humans MeSH
- Pilot Projects MeSH
- Plasmapheresis methods MeSH
- Graft Survival * MeSH
- Prognosis MeSH
- Graft Rejection blood diagnosis immunology pathology MeSH
- Rituximab therapeutic use MeSH
- Drug Administration Schedule MeSH
- Histocompatibility Testing methods MeSH
- Kidney Transplantation * MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- Bortezomib MeSH
- HLA Antigens MeSH
- Adrenal Cortex Hormones MeSH
- Immunologic Factors MeSH
- Isoantibodies MeSH
- Rituximab MeSH
A novel therapeutic approach to refractory acute antibody-mediated rejection (AMR) in kidney transplant recipients was applied in 23 patients based on administration of Bortezomib, intravenous corticosteroids, plasmapheresis and Rituximab. Application of Bortezomib regimen led to diminishing of donor-specific antibodies (DSA) to HLA-B (P = 0.004) and HLA-DR (P = 0.0005), but not to HLA-A (P = 0.106) and HLA-DQ antigens (P = 0.18). Patients with good clinical response to treatment had significantly better allograft survival than recipients with continuing deterioration of graft function (P = 0.019). Graft survival after therapy of refractory AMR was significantly worse than survival after first transplantation and was comparable with outcomes after retransplantation. In conclusion, therapy with Bortezomib was well tolerated and effective in decreasing the levels of HLA-B and -DR antibodies, however, was not successful in depleting HLA-A and -DQ DSA.
Department of Immunogenetics Institute for Clinical and Experimental Medicine Prague Czech Republic
Department of Nephrology Institute for Clinical and Experimental Medicine Prague Czech Republic
Transplant Laboratory Institute for Clinical and Experimental Medicine Prague Czech Republic
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