Volume 8 Issue 5
Sep.  2017
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Du Xin, Sun Zejia, Cai Jifei, et al. Desensitization treatment with bortezomib in a highly-sensitized patient before secondary renal transplantation:report of one case and literature review[J]. ORGAN TRANSPLANTATION, 2017, 8(5): 365-370. doi: 10.3969/j.issn.1674-7445.2017.05.006
Citation: Du Xin, Sun Zejia, Cai Jifei, et al. Desensitization treatment with bortezomib in a highly-sensitized patient before secondary renal transplantation:report of one case and literature review[J]. ORGAN TRANSPLANTATION, 2017, 8(5): 365-370. doi: 10.3969/j.issn.1674-7445.2017.05.006
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Desensitization treatment with bortezomib in a highly-sensitized patient before secondary renal transplantation:report of one case and literature review

doi: 10.3969/j.issn.1674-7445.2017.05.006

  • Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China

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  • Corresponding author: Wang Wei, Email: wangwdoctor@126.com
  • Received Date: 2017-06-20
    Available Online: 2021-01-19
  • Publish Date: 2017-09-15
    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.

     

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