Hardinger Karen L, Alford Kelly, Murillo Daniel
University of Missouri-Kansas City, Division of Pharmacy Practice, USA.
Clin Transpl. 2010:429-36.
Case series have reported the use of bortezomib for treatment of primary and refractory treatment of cell-mediated acute rejection. The purpose of this article is to review a single-center experience with bortezomib used to treat humoral rejection in four transplant recipients. All patients received bortezomib after suffering antibody-mediated rejection refractory to intravenous immunoglobulin and plasmapheresis. Each patient had improved renal function after bortezomib treatment, biopsies became c4d negative in three of the four patients and the level of donor specific antibody reduction was mixed. Adverse drug events were not encountered, although two patients suffered infections, H1N1 pneumonia and cytomegalovirus colitis. In conclusion, these four cases demonstrate the promising use of bortezomib as rescue therapy for 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.
病例系列报告了硼替佐米用于治疗细胞介导的急性排斥反应的初始治疗和难治性治疗。本文的目的是回顾单中心使用硼替佐米治疗4例移植受者体液排斥反应的经验。所有患者在经历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接受硼替佐米治疗。硼替佐米治疗后每位患者的肾功能均有改善，4例患者中有3例活检显示C4d阴性，供体特异性抗体降低水平不一。未发生药物不良事件，尽管有2例患者发生感染，分别为甲型H1N1流感肺炎和巨细胞病毒性结肠炎。总之，这4例病例证明硼替佐米作为抗体介导排斥反应的挽救疗法具有良好前景。需要进一步研究以探索硼替佐米对HLA清除、排斥反应组织学逆转及移植后长期移植物功能的影响。
