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Bortezomib in ABO ‐incompatible kidney transplant desensitization: A case report
Author(s) -
Wong Nikki L,
O'Connell Philip,
Chapman Jeremy R,
Nankivell Brian,
Kable Kathy,
Webster AC,
Wong Germaine
Publication year - 2015
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12424
Subject(s) - bortezomib , plasmapheresis , medicine , abo blood group system , desensitization (medicine) , kidney transplantation , antibody , immunology , proteasome inhibitor , dialysis , kidney , transplantation , multiple myeloma , receptor
Positive B cell crossmatch accompanied by high levels of pre‐transplant human leukocyte antigen donor‐specific antibodies are associated with adverse graft outcomes in kidney transplant recipients. Targeting plasma cells, the main antibody producing cells, with the proteasome inhibitor bortezomib may be a promising desensitization strategy. We report using a combination of bortezomib and plasmapheresis to desensitize a highly sensitized kidney transplant recipient for an ABO ‐incompatible living donor kidney transplant. The flow cytometric B cell crossmatch was positive on presentation. After treatment, the anti‐ A titres fell from 1:64 to 1:4, and a negative B flow cytometric crossmatch was achieved prior to transplantation. The combined approach of bortezomib to abrogate antibody production at the plasma cell level, followed by plasmapheresis and low‐dose intravenous immunoglobulin to remove in‐circulation alloantibodies, has proven to be effective in our case. Bortezomib may play a role in highly sensitized renal transplants.