Therapeutic dosingtiming and efficacy of bortezomib for antibody-mediated kidney transplant rejection
10.3760/cma.j.issn.0254-1785.2019.08.004
- VernacularTitle:硼替佐米治疗肾移植术后AMR的用药时机对治疗效果的影响
- Author:
Wengang HU
1
;
Ya XIAO
;
YaJun SONG
;
Xiao ZHONG
;
Xiaoting XU
;
Mingqi FAN
;
Chibing HUANG
Author Information
1. 陆军军医大学第二附属医院泌尿外科中心
- Keywords:
Kidney transplantation;
DSA;
Rejection;
Bortezomib
- From:
Chinese Journal of Organ Transplantation
2019;40(8):462-467
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore whether therapeutic dosing timing of proteasome inhibitor bortezomib(BZ) would impact its clinical efficacy .Methods From 2012 to 2018 ,35 biopsy-confirmed cases of acute antibody-mediated kidney transplant rejection (AMR) were collected .They received intravenous immunoglobulin (IVIG) plus sirolimus (Sir) plus bortezomib (BZ) .Three groups were assigned according to dosing timing of BZ .After a diagnosis of AMR ,ET (early treatment ) group began BZ dosing within 7 days (n=16) while DT (delayed treatment) group within 8-14 days (n=11) and LT (late treatment) group > 14 days (n= 8).Their clinical parameters and incidence of complications were analyzed .Results DSA reversal rate of ET ,DT and LT groups was 87 .5％ , 45 .5％ and 25 .0％ (P=0 .006) while DSA declining rate 93 .8％ ,90 .9％ and 50％ respectively (P=0 .019);recurrent rate of AMR was lower in ET/DT group than LT group (6 .6％ vs 10％ vs 75％ , P=0 .042) .No significant differences existed in blood perfusion score of allograft at 1 month post-dosing among three groups .In three groups ,creatinine (Cr) of ET group was lower than DT group at month 1/3/12 while DT group was lower than LT group .No significant difference existed in the incidence of adverse reactions among 3 groups .Conclusions More likely to enter the window period , early dosing of BZ is more effective for treating acute AMR .An earlier intervention yields a better efficacy .
