Although several strategies for treating antibody mediated rejection (AMR) in renal transplants have been investigated, the formation of donor-specific antibodies (DSA) and ongoing AMR contribute to late graft loss. However, it remains controversial about the treatment. As a novel treatment, there is accumulating evidence that the proteasome inhibition with bortezomib can improve the renal function of the recipient with late AMR. Herein, we analyzed the outcomes of the patients with late AMR and compared bortezomib therapy (G1) and rituximab therapy (G2).

Between March 2014 and May 2015, 149 cases AMR were diagnosed by renal biopsy based on 13'th Banff classification. Among them, 12 cases received bortezomib (1.3mg/m² I.V) therapy and 85 cases received conventional therapy using rituximab (200mg I.V). All patients treated with steroid, plasmapheresis and selective use of Intravenous immunoglobulin (200mg/kg I.V). Response to therapy was assessed by improvement in sCr, eGFR.

Baseline characteristics and the pathologic scores in biopsy were not significantly different between two groups. However, more severe acute cellular rejection(ACR) was significantly associated with AMR (p=0.042) and past treatment history of ACR or AMR was more frequent in G1 compared to G2 (ACR: 1.33±1.30 vs. 0.57±0.76, p=0.004, AMR: 1.41±1.31 vs. 0.35±0.55, p=0.017). PRA class II was higher in G1(81.67±24.83 vs. 64.05±35.37, p=0.046). After AMR treatment, there were no significant improvement in renal function at 1,2,3 and 5 months respectively, compared to the baseline. Rebiopsy rate was not significantly different, however, the interval between the treatment and rebiopsy was significantly shorter in G1 (3.92±3.34 vs. 6.67±4.28 months, p=0.043). Graft survival after rejection treatment was better in G2 compared to G1 (at 6 months, G1: 64.8% vs. G2: 91.4% and at 1 year, G1: 32.4% vs. G2: 82.1%, p=0.002).

Although this study analyzed short-term follow-up periods, the use of bortezomib as an AMR treatment may not improve the renal function in early periods. This is thought to be that we were using bortezomib as a treatment for refractory AMR. In order to access the accurate effect and establish the indication of bortezomib, large scale and long term follow-up study is needed.

CITATION INFORMATION: Choi J, Jung J, Shin S, Kim Y, Han D. The Early Outcomes of Bortezomib Therapy in Patients with Late Antibody Mediated Rejection in Renal Transplantation. Am J Transplant. 2016;16 (suppl 3).

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