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Bortezomib Eliminates Plasma Cells From a Renal Graft in Plasma Cell–Rich Acute Rejection
- Source :
- Transplantation Proceedings. 51:1732-1738
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Plasma cell-rich acute rejection (PCAR) and antibody-mediated rejection (ABMR), for which a standard treatment has not yet been established, are associated with poor graft survival after kidney transplantation. Here, we report a case series of 3 Japanese patients diagnosed with PCAR accompanied by ABMR. Steroid pulse therapy and rabbit antithymocyte globulin, plasma exchange, intravenous immunoglobulin, and rituximab therapies were sequentially performed in the first case. A graft biopsy after each treatment showed that plasma cell infiltration persisted. Five months after the initiation of rejection therapy, the patient was subjected to bortezomib therapy, which led to the partial elimination of plasma cells from the graft. However, the graft function gradually deteriorated, and hemodialysis treatment was warranted. In the other 2 cases, the patients received the same combination of therapy including bortezomib within a short period. Graft biopsies performed subsequently showed a marked decrease in the number of infiltrated plasma cells, and stabilization of renal graft function was achieved in both cases. Bortezomib, which targets plasma cells, is a potent drug that eliminates infiltrated plasma cells from the graft in PCAR. Thus, in addition to conventional therapy comprising plasma exchange, intravenous immunoglobulin, and rituximab against ABMR, bortezomib may be necessary to administer without any delay to control PCAR.
- Subjects :
- Graft Rejection
Male
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Plasma Cells
Urology
Plasma cell
Bortezomib
Young Adult
Adrenal Cortex Hormones
Biopsy
Humans
Medicine
Kidney transplantation
Retrospective Studies
Transplantation
biology
medicine.diagnostic_test
business.industry
Graft Survival
Immunoglobulins, Intravenous
Plasmapheresis
medicine.disease
Combined Modality Therapy
Kidney Transplantation
medicine.anatomical_structure
Child, Preschool
biology.protein
Female
Surgery
Rituximab
Hemodialysis
Antibody
business
Proteasome Inhibitors
medicine.drug
Subjects
Details
- ISSN :
- 00411345
- Volume :
- 51
- Database :
- OpenAIRE
- Journal :
- Transplantation Proceedings
- Accession number :
- edsair.doi.dedup.....71f8854b7e9b834f08317c847b919a9c