Antibody-mediated rejection (ABMR) is associated with poor renal
allograft survival. It shows poor response to conventional
treatment with
plasmapheresis,
rituximab, and
intravenous immunoglobulin.
Bortezomib, a
proteasome inhibitor used for
treatment of
multiple myeloma, has recently been reported as a
treatment alternative for recipient desensitization and ABMR. A 58-year-old man was diagnosed with mixed-type ABMR with
donor specific
antibodies and acute
T cell-mediated rejection early after
kidney transplantation. Conventional
therapy was administered, including
antithymocyte globulin,
plasmapheresis, and
rituximab; however, his condition was found to be refractory to these antihumoral
therapies. Following
administration of
bortezomib, his
serum creatinine level returned to baseline with stable
graft function. His
serum creatinine level remains stable at 1.3 mg/dL
at 10 months posttransplantation.
Bortezomib is effective for
treatment of refractory ABMR following
kidney transplantation.