Introduction:

ABO incompatible (ABOi) and positive crossmatch (PXM) living donor kidney transplantation is a life-saving alternative to dialysis. A variety of protocols exist utilizing plasmapheresis (PP) and IVIG to desensitize these patients for transplant. Unfortunately, not all patients can be successfully desensitized and are unable to proceed to transplant.

Methods:

A report of 14 patients in which bortezomib was added after failure to convert to an acceptable crossmatch or ABO titer using a standard protocol of PP and low-dose IVIG.

Results:

Of the 14 patients, 7 were ABOi and 7 were PXM. All patients received a 4-dose cycle of bortezomib and no doses needed to be held due to adverse reactions. Within the ABOi group the mean pre-bortezomib titer was 1:219 and the mean post-bortezomib titer was 1:37.

In the PXM group, the mean pre-bortezomib Tcell flow was +42 and Bcell flow +59. The mean post-bortezomib Tcell flow was +34 and Bcell flow +57.

Of the 14 patients, 12 proceeded to transplant (86%) and 2 did not achieve an acceptable crossmatch. Patient survival at 6 months was 93% (13/14;1 patient died in the post-op period due to respiratory failure). Of the 11 remaining patients that reached the 6-month post-transplant mark, 64% (7/11) experienced at least one rejection (1 patient experienced 3 rejections), mean Scr at 6 months post-transplant was 1.78 mg/dl, and graft survival was 100%.

Conclusion:

Bortezomib can be considered an option for desensitization of ABOi and PXM kidney transplant recipients.

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