Successful Treatment of Plasma Cell-Rich Acute Rejection Using Bortezomib: A Case Report

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• Plasma cell-rich acute rejection (PCAR) is a rare but severe form of kidney transplant rejection.
• PCAR is characterized by over 10% plasma cell infiltration and has a poor treatment response and high graft failure rate.
• Current treatment standards for PCAR are lacking.

Observation:

• A kidney transplant recipient with biopsy-proven acute T cell-mediated rejection (TCMR), plasma cell-rich variant, showed persistent inflammation despite standard therapy.
• The patient received bortezomib, a proteasome inhibitor, in addition to maintenance immunosuppressants.
• Following bortezomib treatment, serum creatinine levels improved, and repeat biopsies showed reduced inflammation and fibrosis.

Findings:

• Bortezomib treatment led to significant improvement in graft function and histology in a patient with refractory PCAR.
• The patient's serum creatinine decreased from over 4 mg/dL to 2 mg/dL.
• Repeat biopsy demonstrated resolution of interstitial inflammation and decreased chronicity after bortezomib therapy.

Implications:

• Bortezomib shows potential as an effective therapeutic option for plasma cell-rich acute rejection.
• This finding could offer a new treatment strategy for patients with difficult-to-treat kidney transplant rejection.
• Further research is warranted to confirm bortezomib's efficacy in larger cohorts of PCAR patients.