Bortezomib for acute humoral rejection in two repeat transplant recipients

Case series have reported the use of bortezomib to remove antibodies in live-donor transplant recipients with HLA alloantibodies and to treat antibody and cell-mediated acute rejection. The purpose of this article is to review a single-center experience with bortezomib used to treat humoral rejection in two sensitized, repeat transplant recipients. Both patients received bortezomib after suffering antibody-mediated rejection refractory to intravenous immunoglobulin and plasmapheresis. Short-term follow-up of the case reports presented here demonstrated that renal function has improved after bortezomib treatment while the immunological outcomes were mixed. In the first case the donor specific antibodies initially decreased, but then rebounded and in the second case the DR antibodies decreased while the DQ antibodies increased slightly. In conclusion, these two cases demonstrate the promising use of bortezomib in antibody mediated rejection. Future research is needed to explore the impact of bortezomib on HLA removal, histological reversal of rejection, and long-term graft function after transplantation.