ABSTRACT
Highly sensitized patients represent a challenge in all transplant programs. The use of bortezomib in combination with other strategies could be a real option for some patients. Unfortunately, one single cycle of four doses of bortezomib with 3 PP sessions may not be sufficient. With all the agents available to use in desensitization it is still not clear what is the best combination or who are the best candidates. We need more time and experience with its use to identify which patients could be the best candidate to receive it for desensitization.
Subject(s)
Boronic Acids/therapeutic use , Immunosuppressive Agents/therapeutic use , Kidney Transplantation , Protease Inhibitors/therapeutic use , Pyrazines/therapeutic use , Tissue Donors/supply & distribution , Waiting Lists , Adult , Bortezomib , Down-Regulation , Female , Graft Survival/drug effects , HLA Antigens/immunology , Humans , Isoantibodies/blood , Kidney Transplantation/immunology , Male , Mexico , Middle Aged , Patient Selection , Plasmapheresis , Proteasome Endopeptidase Complex/metabolism , Proteasome Inhibitors , Time Factors , Treatment OutcomeABSTRACT
The use of bortezomib as a treatment modality of AHR improved and stabilized graft function (clinical response) in the majority of patients. Its use in single dose, even combined with rituximab, does not seem to be useful to obtain a sustained clinical response, or to reduce HLAabs level. The use of 4 doses of bortezomib in days 1, 4, 7, and 10 (1.3 mg/m2 BSA each) plus plasmapheresis produced both a good clinical response and a reduction in DSA. Moving forward, it will be necessary to define the long-term effectiveness of bortezomib and whether rituximab administration is indispensable to achieve this goal. Until now, it is evident that many patients needed retreatment and they were well tolerated.
Subject(s)
Academies and Institutes , Boronic Acids/therapeutic use , Graft Rejection/prevention & control , Graft Survival/drug effects , Immunity, Humoral/drug effects , Immunosuppressive Agents/therapeutic use , Kidney Transplantation/immunology , Protease Inhibitors/therapeutic use , Pyrazines/therapeutic use , Acute Disease , Adult , Boronic Acids/administration & dosage , Bortezomib , Drug Administration Schedule , Female , Graft Rejection/immunology , HLA Antigens/immunology , Humans , Immunosuppressive Agents/administration & dosage , Isoantibodies/blood , Male , Mexico , Middle Aged , Plasmapheresis , Protease Inhibitors/administration & dosage , Proteasome Endopeptidase Complex/metabolism , Proteasome Inhibitors , Pyrazines/administration & dosage , Time Factors , Treatment Outcome , Young AdultABSTRACT
The use of bortezomib as a treatment modality of AHR improved and stabilized graft function (clinical response) in the majority of patients. Its use in single dose, even combined with rituximab, does not seem to be useful to obtain a sustained clinical response neither to reduce HLAabs level. The use of 4 doses of bortezomib in days 1, 4, 7, and 10 (1.3 mg/m2 BSA each) plus plasmapheresis produced both a good clinical response and a reduction in DSA. Moving forward, it will necessary to define the long-term effectiveness of bortezomib and whether rituximab administration is indispensable to achieve this goal.
