*Purpose: To evaluate the impact of antibody mediated rejection (AMR) treatment with rituximab combined with bortezomib vs. rituximab alone on patient survival, graft survival, and the clearance of donor specific antibodies (DSAs) in lung transplant recipients (LTRs).

*Methods: A retrospective single center, observational cohort study of 47 adult LTRs who received bortezomib and/or rituximab for treatment of pulmonary AMR from January 2014 to December 2020 was conducted. Included patients were divided into two groups: those that received both bortezomib and rituximab (BR) and those who received rituximab alone (R). Patient survival, graft survival, incidence of infection, and incidence of bronchiolitis obliterans syndrome (BOS) at 1 year post treatment were compared between the groups. Individual DSA mean florescence intensity (MFI) at baseline and 1 month post-treatment, absolute reduction in MFI, and clearance of DSA were compared between treatment groups.

*Results: There were no significant differences in baseline characteristics between groups. No significant differences were found between groups in patient survival, graft survival, incidence of infection, and incidence of BOS (Table 1). When individual DSAs were compared, there was no difference in baseline MFI, absolute MFI reduction, and proportion of DSA cleared (Table 2). Of note, a majority of DSAs identified were Class II.

Table 1. Patient Outcomes at One Year Post-Treatment

Table 2. DSA Outcomes

*Conclusions: The addition of bortezomib to a rituximab-based AMR treatment protocol in LTRs did not significantly impact mortality or re-transplantation at 1 year post-treatment. There was no significant effect on DSA clearance or MFI reduction, BOS development, or infection. In a population of primarily Class II DSAs, no significant differences in outcomes were seen when bortezomib and rituximab were used concurrently compared to rituximab alone for AMR treatment.

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