Efficacy of Bortezomib as an Adjunctive Therapy for Refractory Chronic Active Antibody-Mediated Rejection in Kidney Transplant Patients: A Single-Center Experience
© 2019 Elsevier Inc. Background: Chronic active antibody-mediated rejection (CAMR) has unsatisfactory prognosis in spite of intensive standard antihumoral treatment. Efficacy of additional bortezomib in CAMR remains uncertain. Methods: A retrospective chart review was conducted among kidney transpla...
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th-mahidol.512542020-01-27T16:17:45Z Efficacy of Bortezomib as an Adjunctive Therapy for Refractory Chronic Active Antibody-Mediated Rejection in Kidney Transplant Patients: A Single-Center Experience Nuttasith Larpparisuth Peenida Skulratanasak Nalinee Premasathian Attapong Vongwiwatana Faculty of Medicine, Siriraj Hospital, Mahidol University Medicine © 2019 Elsevier Inc. Background: Chronic active antibody-mediated rejection (CAMR) has unsatisfactory prognosis in spite of intensive standard antihumoral treatment. Efficacy of additional bortezomib in CAMR remains uncertain. Methods: A retrospective chart review was conducted among kidney transplant patients with biopsy-proven CAMR. Our standard CAMR protocol included plasma exchange, intravenous immunoglobulin, and rituximab. Repeated treatment was provided for refractory cases. Patients receiving at least 1 course of bortezomib were enrolled as the bortezomib group. Allograft outcome was compared among patients receiving repeated standard protocol alone and the bortezomib group. Results: Thirteen and 15 patients were assigned to the bortezomib and control groups, respectively. Repeated bortezomib protocol was given for 1, 2, 3, and 4 courses in 6, 4, 1, and 2 patients, respectively. With a median follow-up time after treatment of 41.8 (18.3-47.4) months, the bortezomib group had a lower rate of glomerular filtration rate declination (-4.20 ± 4.89 mL/min/y vs -12.33 ± 10.44 mL/min/y; P =.014), a higher rate of disappearance of donor specific antibodies (69.2% vs 25%; P =.03), a lower rate of allograft loss (15.4% vs 66.7%; P =.006), and better allograft survival (P =.006). Conclusion: In CAMR, additional bortezomib treatment was more effective in eliminating donor specific antibodies and improving allograft survival than standard protocol treatment. 2020-01-27T09:17:45Z 2020-01-27T09:17:45Z 2019-12-01 Article Transplantation Proceedings. Vol.51, No.10 (2019), 3293-3296 10.1016/j.transproceed.2019.07.022 18732623 00411345 2-s2.0-85075351497 https://repository.li.mahidol.ac.th/handle/123456789/51254 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85075351497&origin=inward |
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Medicine Nuttasith Larpparisuth Peenida Skulratanasak Nalinee Premasathian Attapong Vongwiwatana Efficacy of Bortezomib as an Adjunctive Therapy for Refractory Chronic Active Antibody-Mediated Rejection in Kidney Transplant Patients: A Single-Center Experience |
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© 2019 Elsevier Inc. Background: Chronic active antibody-mediated rejection (CAMR) has unsatisfactory prognosis in spite of intensive standard antihumoral treatment. Efficacy of additional bortezomib in CAMR remains uncertain. Methods: A retrospective chart review was conducted among kidney transplant patients with biopsy-proven CAMR. Our standard CAMR protocol included plasma exchange, intravenous immunoglobulin, and rituximab. Repeated treatment was provided for refractory cases. Patients receiving at least 1 course of bortezomib were enrolled as the bortezomib group. Allograft outcome was compared among patients receiving repeated standard protocol alone and the bortezomib group. Results: Thirteen and 15 patients were assigned to the bortezomib and control groups, respectively. Repeated bortezomib protocol was given for 1, 2, 3, and 4 courses in 6, 4, 1, and 2 patients, respectively. With a median follow-up time after treatment of 41.8 (18.3-47.4) months, the bortezomib group had a lower rate of glomerular filtration rate declination (-4.20 ± 4.89 mL/min/y vs -12.33 ± 10.44 mL/min/y; P =.014), a higher rate of disappearance of donor specific antibodies (69.2% vs 25%; P =.03), a lower rate of allograft loss (15.4% vs 66.7%; P =.006), and better allograft survival (P =.006). Conclusion: In CAMR, additional bortezomib treatment was more effective in eliminating donor specific antibodies and improving allograft survival than standard protocol treatment. |
author2 |
Faculty of Medicine, Siriraj Hospital, Mahidol University |
author_facet |
Faculty of Medicine, Siriraj Hospital, Mahidol University Nuttasith Larpparisuth Peenida Skulratanasak Nalinee Premasathian Attapong Vongwiwatana |
format |
Article |
author |
Nuttasith Larpparisuth Peenida Skulratanasak Nalinee Premasathian Attapong Vongwiwatana |
author_sort |
Nuttasith Larpparisuth |
title |
Efficacy of Bortezomib as an Adjunctive Therapy for Refractory Chronic Active Antibody-Mediated Rejection in Kidney Transplant Patients: A Single-Center Experience |
title_short |
Efficacy of Bortezomib as an Adjunctive Therapy for Refractory Chronic Active Antibody-Mediated Rejection in Kidney Transplant Patients: A Single-Center Experience |
title_full |
Efficacy of Bortezomib as an Adjunctive Therapy for Refractory Chronic Active Antibody-Mediated Rejection in Kidney Transplant Patients: A Single-Center Experience |
title_fullStr |
Efficacy of Bortezomib as an Adjunctive Therapy for Refractory Chronic Active Antibody-Mediated Rejection in Kidney Transplant Patients: A Single-Center Experience |
title_full_unstemmed |
Efficacy of Bortezomib as an Adjunctive Therapy for Refractory Chronic Active Antibody-Mediated Rejection in Kidney Transplant Patients: A Single-Center Experience |
title_sort |
efficacy of bortezomib as an adjunctive therapy for refractory chronic active antibody-mediated rejection in kidney transplant patients: a single-center experience |
publishDate |
2020 |
url |
https://repository.li.mahidol.ac.th/handle/123456789/51254 |
_version_ |
1763493301002960896 |