Despite of tradifional treatments for AMR, such as plasapheresis, ingravenous immunoglobulin, and rituximab, current treatment for antibody-mediated rejection(AMR) after renal transplantation is insufficient. Recently, Bortezomib has been used for refractory late AMR. Thus, we reviewed our cases that treat late AMR with bortezomib and investigate the effect of bortezomib in renal transplantation. We treated 22 cases with bortezomib for late AMR. One case is diagnosed late AMR based on serologic test and the others were based on renal biopsy. Bortezomoib(1.3mg/m²) was administered on days 1,4,8,and 11. Clinical characteristics, biopsy findings assessed by 2013 Banff criteria, donor specific antibodies(DSA), renal function, and graft survival were analyzed. AMR and acute cellular rejection were accompanied in 21cases and C4d+ were identified in 10 cases. MI score (g+ptc) was 4.23±1.31. Number of previous rejection treatment history was 2.0±1.8. There were significant improvement in the mean eGFR (21.09±10.88 vs. 24.10±12.99 at 2 weeks, p=0.014; 21.09±10.88 vs. 33.15±11.66 at 6 months, p=0.046) and sCr (3.93±2.55 vs. 3.51±2.41 at 2 weeks, p=0.023; 3.93±2.55 vs. 2.40±1.20 at 6 months, p=0.046) at 2 weeks and 6 months after treatment comparing those at the time of AMR diagnosis. MFI of DSA were significantly decreased after treatment ( Class I , 7254.0±4025.2 vs. 4732.8±3188.0, p=0.056 ; Class II 11225.2±5847.0 vs. 8953.7±5008.6, p=0.005). However, 13(59.1%) cases performed renal biopsy again within 220.8±143.8(1-511)days. Graft failure were developed in 8 cases(36.4%) and it took 12.7±7.2months (1-23) after treatment. Bortezomib can be effective on decreasing the MFI of DSA as anti-humoral treatment in late AMR. And it showed improvement of renal function in early periods. However, it is uncertain whether it can be useful for maintain graft function of not. Large scales and long-term follow-up study is needed.

CITATION INFORMATION: Choi J, Jung J, Chun S, Shin S, Kim Y, Han D. Bortezomib for Late Antibody-Mediated Rejection After Renal Transplantation: A Single Center Experience of 22 Cases. Am J Transplant. 2017;17 (suppl 3).

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