Shapiro R, Lunz J, Zeevi A, Basu A, Mapara M, Randhawa P, Tan H P, Sharma V, Humar A
Univ of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA.
Clin Transpl. 2010:405-7.
In summary, 1.7 years after transplantation, bortezomib rescue has been durably effective in salvaging our patient with refractory antibody mediated rejection. The only price has been persistently high levels of BK viruria. The presence of ongoing and even recurrent donor specific antibody has made it difficult to reduce immunosuppression further, and the concern that the high levels of BK viruria will eventually progress to viremia and nephropathy necessitates continued therapy with very low dose cidofovir and leflunomide. The absence of C1q binding DSA with stable renal function may provide some reserved optimism that the DSA that is detectable by convention Luminex assay may have reduced pathological implications. However, more data and prolonged follow-up are needed to determine whether or not non-complement binding DSA has an adverse pathological role.
总之，移植1.7年后，硼替佐米挽救治疗在挽救我们这位难治性抗体介导排斥反应患者方面一直具有持久疗效。唯一代价是BK病毒尿水平持续居高不下。持续存在甚至复发的供体特异性抗体使得进一步降低免疫抑制变得困难，而且担心高水平的BK病毒尿最终会发展为病毒血症和肾病，因此有必要继续使用极低剂量的西多福韦和来氟米特进行治疗。未检测到C1q结合的供体特异性抗体且肾功能稳定，这或许能带来一些保留性的乐观态度，即通过传统Luminex检测法可检测到的供体特异性抗体可能已降低了病理影响。然而，需要更多数据和更长时间的随访来确定非补体结合的供体特异性抗体是否具有不良病理作用。
