Antibody-Mediated Rejection Treatment With Bortezomib in Renal Transplant Recipients: A Single-Center 24-Month Follow-up Case Report.

Autor: Bahena Méndez J; Nephrology Fellowship Program, Universidad Nacional Autónoma de México Facultad de Medicina, México City, México., López Y López LR; Nephrology Fellowship Program, Universidad Nacional Autónoma de México Facultad de Medicina, México City, México., Sebastián Díaz MA; Nephrology, Hospital Central Sur Alta Especialidad 'Picacho,' Petróleos Mexicanos, México City, México., Trejo Curiel I; Nephrology Fellowship Program, Universidad Nacional Autónoma de México Facultad de Medicina, México City, México., Galindo-Lopéz R; Nephrology Fellowship Program, Universidad Nacional Autónoma de México Facultad de Medicina, México City, México., Baca Córdova A; Nephrology Fellowship Program, Universidad Nacional Autónoma de México Facultad de Medicina, México City, México., Wasung de Lay M; Nephrology, Hospital Central Sur Alta Especialidad 'Picacho,' Petróleos Mexicanos, México City, México., Vázquez Dávila RA; Transplant, Hospital Central Sur Alta Especialidad 'Picacho,' Petróleos Mexicanos, México City, México., Zarate Rodríguez PA; Central Laboratory, Hospital Central Sur Alta Especialidad 'Picacho,' Petróleos Mexicanos, México City, México., Carmona-Escamilla MA; Nephrology, Hospital Central Sur Alta Especialidad 'Picacho,' Petróleos Mexicanos, México City, México. Electronic address: marcoantoniocarmona@gmail.com.
Jazyk: angličtina
Zdroj: Transplantation proceedings [Transplant Proc] 2020 May; Vol. 52 (4), pp. 1123-1126. Date of Electronic Publication: 2020 Mar 26.
DOI: 10.1016/j.transproceed.2020.01.067
Abstrakt: Introduction: Antibody-mediated rejection (AMR) is related to a poor prognosis in graft survival, with 27% to 40% of patients experiencing graft loss within the first year. The mechanism of damage in AMR is mediated by donor-specific antibodies (DSA). No standard treatment for AMR exists, and conventional management includes high doses of steroids, plasmapheresis, intravenous immunoglobulin, and either rituximab or bortezomib. Because of the high cost of these medications and the lack of prospective studies to evaluate their efficacy and safety, their routine use is limited. In the following study, we describe the use of bortezomib for the treatment of AMR in 5 renal transplant recipients with a 24-month follow-up and compare this case with the reviewed literature.
Material and Methods: Five cases of AMR diagnosed by biopsy are reported, and these patients received bortezomib at a rate of 1.3 mg/m 2 on days 1, 4, 8, and 11; plasmapheresis; and 1 patient received 30 g of intravenous immunoglobulin.
Results: All patients received his or her first transplant; 4 were from a cadaveric donor, and 1 patient received thymoglobulin at a standard dose. All patients had maintenance therapy based on cyclosporine, mycophenolate mofetil, and prednisone, with an average baseline creatinine level of 1.3 mg/dL. The average days until rejection event were 952 days.
Discussion and Conclusion: AMR treatment with bortezomib was effective, showing stable renal function at 24 months. Patients had adequate tolerance for administration. So far, these results contrast with the literature reviewed, so additional studies and follow-up are required for a new evaluation.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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