Bahena Méndez J, López Y López L R, Sebastián Díaz M A, Trejo Curiel I, Galindo-Lopéz R, Baca Córdova A, Wasung de Lay M, Vázquez Dávila R A, Zarate Rodríguez P A, Carmona-Escamilla M A
Nephrology Fellowship Program, Universidad Nacional Autónoma de México Facultad de Medicina, México City, México.
Nephrology, Hospital Central Sur Alta Especialidad "Picacho," Petróleos Mexicanos, México City, México.
Transplant Proc. 2020 May;52(4):1123-1126. doi: 10.1016/j.transproceed.2020.01.067. Epub 2020 Mar 26.
Antibody-mediated rejection (AMR) is related to a poor prognosis in graft survival, with 27% to 40% of patients experiencing graft loss within the first year. The mechanism of damage in AMR is mediated by donor-specific antibodies (DSA). No standard treatment for AMR exists, and conventional management includes high doses of steroids, plasmapheresis, intravenous immunoglobulin, and either rituximab or bortezomib. Because of the high cost of these medications and the lack of prospective studies to evaluate their efficacy and safety, their routine use is limited. In the following study, we describe the use of bortezomib for the treatment of AMR in 5 renal transplant recipients with a 24-month follow-up and compare this case with the reviewed literature.
Five cases of AMR diagnosed by biopsy are reported, and these patients received bortezomib at a rate of 1.3 mg/m on days 1, 4, 8, and 11; plasmapheresis; and 1 patient received 30 g of intravenous immunoglobulin.
All patients received his or her first transplant; 4 were from a cadaveric donor, and 1 patient received thymoglobulin at a standard dose. All patients had maintenance therapy based on cyclosporine, mycophenolate mofetil, and prednisone, with an average baseline creatinine level of 1.3 mg/dL. The average days until rejection event were 952 days.
AMR treatment with bortezomib was effective, showing stable renal function at 24 months. Patients had adequate tolerance for administration. So far, these results contrast with the literature reviewed, so additional studies and follow-up are required for a new evaluation.
抗体介导的排斥反应（AMR）与移植物存活的不良预后相关，27%至40%的患者在第一年内出现移植物丢失。AMR的损伤机制由供体特异性抗体（DSA）介导。目前尚无AMR的标准治疗方法，传统治疗包括高剂量类固醇、血浆置换、静脉注射免疫球蛋白以及利妥昔单抗或硼替佐米。由于这些药物成本高昂且缺乏评估其疗效和安全性的前瞻性研究，其常规使用受到限制。在以下研究中，我们描述了硼替佐米用于治疗5例肾移植受者AMR的情况，并进行了24个月的随访，并将该病例与已发表文献进行比较。
报告了5例经活检诊断为AMR的病例，这些患者在第1、4、8和11天接受了1.3mg/m²剂量的硼替佐米治疗、血浆置换；1例患者接受了30g静脉注射免疫球蛋白。
所有患者均接受了首次移植；4例来自尸体供体，1例患者接受了标准剂量的抗胸腺细胞球蛋白。所有患者均接受基于环孢素、霉酚酸酯和泼尼松的维持治疗，平均基线肌酐水平为1.3mg/dL。至排斥事件的平均天数为952天。
用硼替佐米治疗AMR是有效的，在24个月时肾功能稳定。患者对给药有足够的耐受性。到目前为止，这些结果与所回顾的文献不同，因此需要进行更多的研究和随访以进行新的评估。
