Comparison of Bortezomib in Addition to Rituximab Based Treatment of Acute Antibody Mediated Rejection in Kidney Transplantation
1Nephrology & Hypertension, University of Miami, Miami, FL
2Miami Transplant Institute, Jackson Memorial Hospital, Miami, FL.
Meeting: 2018 American Transplant Congress
Abstract number: A104
Keywords: Glomerular filtration rate (GFR), Graft failure, Panel reactive antibodies, Rejection
Session Information
Session Name: Poster Session A: Kidney Acute Antibody Mediated Rejection
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
Purpose:
The optimal treatment strategy of acute antibody mediated rejection (AMR) in renal allograft recipients remains undefined. The aim of our study was to compare the efficacy of the addition of Bortezomib to our standard treatment.
Methods:
We retrospectively analyzed 78 patients (p) with biopsy proven acute AMR at the Miami Transplant Institute. From November 2012 until January 2015, 41 p (group A) received standard treatment with rituximab (R: 375 mg/m2 x1), plasmapheresis x 3-7 and intravenous immunoglobulin (IVIG: 2g/kg). From August 2014 until January 2016, 37 p (group B) received plasmapheresis followed by bortezomib 1.3mg/m2 on days 1,4,7,10 with maintenance IVIG (0.1g/kg) and rituximab (375 mg/m2 x1). Rabbit anti-thymocyte globulin was used for histological evidence of T-cell mediated rejection in both groups.
Results:
The demographic variables between the groups were not statistically significant. Serum creatinine (SCr) at biopsy, 3, 6 and 12 months (m) was: 3.2 ± 1.7, 2.4 ± 0.9, 2.7 ± 1.6 and 2.7 ± 1.4 mg/dl in group A and 2.6 ± 2.2, 2.2 ± 1.6, 2.6 ± 2.6 and 2.2 ± 1.4 mg/dl in Group B. eGFR was 33 ± 18, 34 ± 12, 34 ± 15 and 36 ± 15 ml/min at biopsy, 3, 6 and 12 m in Group A and 44 ± 20, 41 ± 23, 40 ± 23, and 45 ± 23 in Group B (p=0.03 at 12m). Calculated panel reactive antibodies (cPRA) was 77 ± 27% and 67 ± 32% in Group A and 55.2 ± 34% and 61 ± 34% in Group B at biopsy and 6 m, respectively. Second episode of AMR within 12 m occurred 27% in both groups. Graft failure within 12 m occurred in 9 p (22%) in Group A, vs 7 p (19%) in Group B. 2 death occurred in Group A and none in Group B. 15% in Group A and 16% in Group B had serious infections. None of these clinical variables reached statistical significance.
Conclusions:
The addition of Bortezomib to our standard treatment of AMR did not significantly improve early graft function or failure; however, we found statistically significant improvement of eGFR at 12 m. Further detailed multivariable analysis is needed to confirm this finding.
CITATION INFORMATION: Mattiazzi A., Pagan J., Arunachalam A., De la Cruz Alcantara I., Revollo J., Centeno A., Valdes A., Guerra G. Comparison of Bortezomib in Addition to Rituximab Based Treatment of Acute Antibody Mediated Rejection in Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Mattiazzi A, Pagan J, Arunachalam A, Revollo J, Centeno A, Valdes A, Guerra G. Comparison of Bortezomib in Addition to Rituximab Based Treatment of Acute Antibody Mediated Rejection in Kidney Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/comparison-of-bortezomib-in-addition-to-rituximab-based-treatment-of-acute-antibody-mediated-rejection-in-kidney-transplantation/. Accessed June 27, 2025.« Back to 2018 American Transplant Congress