The Effect of Bortezomib on DSA Reduction During the Treatment of AMR in Pediatric Kidney Transplant Patients.
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
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).
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.« Back to 2016 American Transplant Congress