Bortezomib as the sole post-renal transplantation desensitization agent does not decrease donor-specific anti-HLA...

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• Donor-specific anti-HLA antibodies (DSA) persistence post-kidney transplant is linked to antibody-mediated rejection and poor graft survival.
• Targeting plasma cells with proteasome inhibitors like bortezomib is a potential desensitization strategy.

Observation:

• This study assessed bortezomib's efficacy as a sole desensitization therapy in four kidney transplant recipients with subacute antibody-mediated rejection and high DSA levels.
• Bortezomib treatment involved one cycle of four doses (1.3 mg/m(2) each).

Findings:

• Bortezomib did not significantly decrease DSA levels within 150 days post-treatment in any patient.
• Antivirus antibody levels (HBV, VZV, HSV) remained stable, indicating no significant impact on long-lived plasma cells.

Implications:

• One cycle of bortezomib monotherapy is insufficient to lower DSA in sensitized kidney transplant recipients within the observed timeframe.
• Rigorous, prospective, randomized, and controlled studies are essential to properly evaluate bortezomib's role in desensitization strategies.