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The Effect of Bortezomib on DSA Reduction During the Treatment of AMR in Pediatric Kidney Transplant Patients.

O. Moussa, S. Self, K. Twombley.

Medical University of South Carolina, Charleston, SC.

Meeting: 2016 American Transplant Congress

Abstract number: D160

Keywords: Rejection

Session Information

Date: Tuesday, June 14, 2016

Session Name: Poster Session D: Kidney-Pediatrics

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

Related Abstracts
  • Treatment of Late Onset De Novo Donor Specific Antibody (DSA)-Mediated Pediatric Kidney Transplant Rejection with Bortezomib
  • Adjunctive Bortezomib Therapy for Treatment of Antibody Mediated Rejection in Kidney Transplant Recipients

Introduction: The optimal therapy for AMR is not well defined in children or adults. AMR carries a worse prognosis than ACR and can lead to high levels of anti-HLA antibodies, making re-transplantation more difficult. There is little evidence of the effect of Bortezomib in children on its ability to decrease DSA.

Objective: To examine the effects of Bortezomib treatment on DSA.

Methods: A retrospective chart review was conducted of children receiving treatment for AMR of a kidney transplant from July of 2012 to October of 2015. All patients were treated with Bortezomib.

Drug

Dose

Route

Days

Rituximab

375mg/m2/dose

IV

0

Bortezomib

1.3mg/m2/dose

IV

0,3,6,9

IVIg

2gm/kg

IV

12

PE (pre-Bortezomib and Rituximab doses)

1.5 times volume

IV

0,3,6,9,12

Single Antigen (SA) beads analysis was performed using the LABScreen® assay and Luminex platform (One Lambda). Signal amplification was performed using biotinylated goat anti-human IgG secondary antibodies and StreptAvidin-PE.

Results: 7 patients were treated during this time. Most of the patients had significant decreases in their DSA MFIs, regardless if they lost the graft or not.

 

DSA

DSA pre-treatment  MFI

DSA 1mo post-treatment  MFI

DSA 2-4mo post-treatment  MFI

% Decrease

Patient 1

DQ5

DQ8

B44

13137

4782

4923

4713

4713

400

4923

2174

0

62.5%

54.5%

100%

Patient 2

B44

DQ6

DR15

2595

2595

900

238

14169

197

254

9859

384

90%

0

57.3%

Patient 3

DQ2

DQ6

DR17

DR13

DR52

21967

11980

1121

2058

1232

20310

7651

0

0

0

11678

647

0

0

55

46.8%

94.5%

100%

100%

95.5%

Patient 4

A24

DR17

DR52

8724

4268

6359

 

2235

256

3509

74.4%

94%

44.8%

Patient 5

DR53

15950

7518

9134

42.7%

Patient 6

DQ6

DQ8

DR4

DR15

10969

18628

2255

2983

4959

17301

1131

820

5753

14796

925

524

47.6%

20.6%

59%

82.4%

Patient 7

DQ6

17186

4594

 

73.3%

Class II DSA tended to be more treatment resistant than class I DSA.

Conclusion: Overall, there was a decrease in DSA MFI with Bortezomib treatment. Even if patients loose the graft from AMR, the reduction in DSA is still clinically significant as it could potentially lead to lower PRAs at the time of re-transplant. Longer monitoring needs to be done to determine if the decrease in DSA is transient or persistent.

CITATION INFORMATION: Moussa O, Self S, Twombley K. The Effect of Bortezomib on DSA Reduction During the Treatment of AMR in Pediatric Kidney Transplant Patients. Am J Transplant. 2016;16 (suppl 3).

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To cite this abstract in AMA style:

Moussa O, Self S, Twombley K. The Effect of Bortezomib on DSA Reduction During the Treatment of AMR in Pediatric Kidney Transplant Patients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/the-effect-of-bortezomib-on-dsa-reduction-during-the-treatment-of-amr-in-pediatric-kidney-transplant-patients/. Accessed March 6, 2021.

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