Hardinger Karen L, Alford Kelly, Murillo Daniel
University of Missouri-Kansas City, Division of Pharmacy Practice, USA.
Clin Transpl. 2009:479-83.
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.
病例系列报告了使用硼替佐米清除具有HLA同种抗体的活体供体移植受者体内的抗体，并治疗抗体介导和细胞介导的急性排斥反应。本文的目的是回顾单中心使用硼替佐米治疗两名致敏的再次移植受者体液排斥反应的经验。两名患者在经历了对静脉注射免疫球蛋白和血浆置换难治的抗体介导排斥反应后均接受了硼替佐米治疗。此处呈现的病例报告的短期随访表明，硼替佐米治疗后肾功能有所改善，而免疫结果则好坏参半。在第一个病例中，供体特异性抗体最初下降，但随后反弹，在第二个病例中，DR抗体下降，而DQ抗体略有增加。总之，这两个病例证明了硼替佐米在抗体介导排斥反应中的应用前景广阔。未来需要开展研究，以探索硼替佐米对HLA清除、排斥反应的组织学逆转以及移植后长期移植物功能的影响。
