A summary of bortezomib use in transplantation across 29 centers.

Despite the substantial effects and promise of bortezomib-based regimens, there is still much to be learned. Finding an effective approach to removing antibodies is an ultimate goal. At this time it seems that bortezomib is a key element in improving the treatment for rejection (both acute and chronic) and in desensitization. In regard to such clinical outcomes as achieving transplant and stabilizing allograft function, bortezomib-based regimens have shown in the cases presented here to have a high success rate, albeit lower with desensitization and chronic rejection than with acute rejection. Bortezomib, even in combination regimens, has also shown a good safety profile, although side effects such a thrombocytopenia, gastrointestinal disturbances, and even peripheral neuropathy have been reported in transplant patients following treatment. In addition, bortezomib's safety regarding viral reactivation of cytomegalovirus, Epstein Barr virus, and BK virus are not clearly known, therefore precautions must be taken (especially in combination regimens). Moving forward, continual data collection and trials will be needed to answer questions about bortezomib. Hopefully, this effort and future efforts to collectively gather data and collaborate with a common goal of treating antibodies will lead us to improved long term allograft survival.