Backgroud: The best choice to treat AMR is not supported by several evidences, and recently the interest in drugs as Bortezomib has improved. Aim: Evaluted the kinetics of donor specific antibody (DSA) and results in patients with AMR who were treated with plasmapheresis (PP) and Bortezomib. Methods: We evaluted the episodes of AMR diagnosed between 2007 and 2014 (all patients had 1 year of follow up – at least). The diagnose was performed according Banff'07. The treatment consisted in PP added only one dose of Imunoglobulin (0.4g/kg) following the last PP. Bortezomib was used in patients who did not reduce the highest DSA or sum of DSA more than 50% after 6 PP. DSA was detected by Luminex and expressed in mfi. The antibody kinetics was evaluted using three variables: the highest DSA, all DSA and sum of DSA. Results: AMR incidence was 4.2% (N=32). Patients were pre sensitized: 6±17.8 unit of blood transfusion, 25% of re transplantation and 18.7% of patients had been submited to dessensitization; cPRA-I 33.7% and II 23.2%. The time to diagnose was 14 days [8-883] and 81.5% patients had diagnose in the first month posttransplant. The changes in biopsies were: ATN-30%, PTC- 58.8%, TMA-6.6% and other-6,6%; C4d was negative in 20%. More than one DSA were indetified in 43.7% of patients. The number of PP was 7.9±6.3. Regarding total treatment we observed significant reduction in all variables of kinetics: highest DSA from 6.436 to 1.175 (p<0.001); all DSA (N=56) from 4.872 to 1.087 (P<0.001); sum of DSA from 7.395 to 1.966 (p<0.001). Bortezomib was used in 22% (N=7) and the antibody kinetics was determined by mfi at moment of AMR diagnose(T0), before Bortezomib (T1) and 4 weeks after (T2). The mfi values to all DSA (N=19) were from 3.931 (T0) to 3.275 (T1) and to 1.308 (T2, p=0.008) and to sum of DSA (N=7) were from 14.657 (T0) to 12.896 (T1) and to 2.057 (T2, p=0.006). One year renal function, graft and patient survival were 1.63±0.80 mg/dl, 81.1% and 100%, repectively. Conclusions: The incidence of AWR was according to previously published. The treatment using PP was efetive in more than 80% of patients and we observed a good response with Bortezomib in patients who did not response to PP.

CITATION INFORMATION: Requião-Moura L, Afonso M, Sakashita A, Silva M, Matos A, Pacheco-Silva A. Donor Specif Antibody (DSA) Kinetics in Patients with Antibody Mediated Rejection (AMR) Treated with Plasmapheresis and Bortezomib. Am J Transplant. 2016;16 (suppl 3).

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