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The Effect of Bortezomib on Antibody-Mediated Rejection after Kidney Transplantation

 Juhan Lee  ;  Beom Seok Kim  ;  Yongjung Park  ;  Jae Geun Lee  ;  Beom Jin Lim  ;  Hyeon Joo Jeong  ;  Yu Seun Kim  ;  Kyu Ha Huh 
 YONSEI MEDICAL JOURNAL, Vol.56(6) : 1638-1642, 2015 
Journal Title
Issue Date
Adolescent ; Adult ; Antibodies, Monoclonal/therapeutic use ; Antineoplastic Agents/therapeutic use* ; Boronic Acids/therapeutic use ; Bortezomib/therapeutic use* ; Female ; Graft Rejection/drug therapy* ; Graft Rejection/prevention & control* ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Immunologic Factors/therapeutic use ; Isoantibodies ; Kidney Failure, Chronic/surgery* ; Kidney Transplantation* ; Male ; Middle Aged ; Plasmapheresis ; Pyrazines/administration & dosage ; Transplantation, Homologous
Angiotensin II type 1 receptor antibodies ; HLA antibodies ; antibody-mediated rejection ; bortezomib ; kidney transplantation
PURPOSE: Recently, bortezomib has been used to treat antibody-mediated rejection (AMR) refractory to conventional treatment such as plasmapheresis, intravenous immunoglobulin, and rituximab. The authors aimed to describe their experiences when bortezomib was used to treat refractory AMR. MATERIALS AND METHODS: Eleven refractory AMR episodes treated with bortezomib were included in this study. The patients received one or two cycles of bortezomib (1.3 mg/m²) on days 1, 4, 8, and 11. RESULTS: Bortezomib effectively reduced antibodies against various targets, including human leukocyte antigen (HLA) class I and II, ABO blood group antigen, and angiotensin II type 1 receptor. Antibodies were depleted or reduced significantly in eight AMR episodes. Overall, there was a significant improvement in the mean estimated glomerular filtration rate (eGFR) at 3 months after therapy (36.91±22.15 mL/min/1.73 m²) versus eGFR at time of AMR diagnosis (17.00±9.25 mL/min/1.73 m²; p=0.007). All six early-onset AMR episodes (within 6 months post-transplantation) showed full recovery of allograft function. Additionally, three of the five late-onset AMR episodes (>6 months post-transplantation) showed improved allograft function. CONCLUSION: Anti-humoral treatment based on bortezomib might be an effective strategy against refractory AMR caused by various types of antibodies. Notably, this treatment could be more effective in early-onset AMR than in late-onset AMR.
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Beom Seok(김범석) ORCID logo https://orcid.org/0000-0002-5732-2583
Kim, Yu Seun(김유선) ORCID logo https://orcid.org/0000-0002-5105-1567
Park, Yong Jung(박용정)
Lee, Jae Geun(이재근) ORCID logo https://orcid.org/0000-0002-6722-0257
Lee, Ju Han(이주한)
Lim, Beom Jin(임범진) ORCID logo https://orcid.org/0000-0003-2856-0133
Jeong, Hyeon Joo(정현주) ORCID logo https://orcid.org/0000-0002-9695-1227
Huh, Kyu Ha(허규하) ORCID logo https://orcid.org/0000-0003-1364-6989
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