Desensitization treatment with bortezomib in a highly-sensitized patient before secondary renal transplantation: report of one case and literature review
10.3969/j.issn.1674-7445.2017.05.006
- VernacularTitle:高致敏二次肾移植患者术前应用硼替佐米行脱敏治疗1例报告及文献复习
- Author:
Xin DU
1
;
Zejia SUN
;
Jifei CAI
;
Xin LI
;
Hang LIU
;
Liang REN
;
Xiaodong ZHANG
;
Wei WANG
Author Information
1. 首都医科大学附属北京朝阳医院泌尿外科
- Keywords:
Renal transplantation;
Donor specific antibody (DSA);
Bortezomib;
Desensitization;
Immunoglobulin;
Antibody mediated rejection (AMR),Chronic,Active;
C4d;
C3d;
Peripheral neuropathy;
Renal function;
Tacrolimus (FK506)
- From:
Organ Transplantation
2017;8(5):365-370
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the clinical experience of the application of bortezomib desensitization regime prior to secondary renal transplantation in a highly-sensitized recipient. Methods At 13, 10 and 6 d prior to secondary renal transplantation, one patient positive for donor specific antibody (DSA) was subcutaneously administered with bortezomib at a dose of 1.3 mg/m2 combined with a low dose of immunoglobulin. Postoperatively, immunosuppressive regime of tacrolimus (FK506), mycophenolat sodium and methylprednisolone was adopted. The serum creatinine (Scr), blood urea nitrogen (BUN) levels, FK506 concentration, DSA titre, C3d binding DSA (C3d-DSA) titre, pathological biopsy of the renal graft and adverse reactions were observed. Results During 12-month follow-up after administration of bortezomib, the Scr level was declined and maintained at 130 μmol/L, and the BUN level was remained at 3.9 mmol/L. The DSA level was significantly decreased and the C3d-DSA was negative. At postoperative 4 and 9 months, pathological biopsy of the renal graft revealed that the patient was positive for C4d, prompting the chronic active antibody mediated rejection (AMR). The patient presented with grade Ⅲ peripheral neuropathy. Conclusions Application of preoperative bortezomib desensitization regime can effectively down-regulate the DSA level in the recipient and avert the incidence of acute rejection in highly-sensitized patients undergoing secondary renal transplantation. Comprehensive treatment using bortezomib is recommended for preoperative desensitization in the highly-sensitized transplant recipients.
