AIM: Acute antibody-mediated rejection (AMBR) after kidney transplantation (KT) is associated with poor allograft survival. Current therapies for ABMR are able to deplete B-lymphocytes but do not target plasma cells. @entity1749 is a proteasome inhibitor that can eliminate plasma cells and has demonstrated utility in the treatment of ABMR. METHODS: Retrospective study from 2010 to 2014, including all @entity1 with ABMR refractory to conventional treatment who received @entity1749 . @entity1749 (1.3   mg/m(2) ) was administered intravenously on days 1, 4, 8, and 11. Renal function, graft survival, follow-up biopsies, and donor-specific antibodies (DSA) were recorded. RESULTS: We identified seven @entity1 . Of these, high immunological risk was found in 6 of 7, preformed DSA were found in 5 of 7, flow cytometry crossmatch was positive in 4 of 7, and desensitization before KT was provided in 6 of 7 @entity1 . ABMR was diagnosed at a median of 90   days (8-167) post-KT. After @entity1749 therapy, renal function improved or stabilized in 5 of 7 @entity1 and progressively deteriorated in 2 of 7, leading to hemodialysis after 7 and 11   months, respectively. Follow-up kidney biopsies showed persistence of ABMR in 2 of 7, chronic active ABMR 3 of 7 and inactive chronic lesions in 2 of 7. DSA titers significantly decreased after treatment (p 0.028). All @entity1 experienced mild adverse events. After a follow-up of 22        18   months, three grafts were lost (42%) and four remained functioning. CONCLUSIONS: @entity1749 could be useful as an adjuvant therapy for ABMR refractory to conventional treatment with acceptable mid-term outcomes in these severe cases. More research is needed to develop strategies to better preserve graft function after refractory ABMR.

XXXX for refractory acute antibody-mediated rejection in kidney transplant recipients. A single-center case series.

@entity1749 :: ('MESH:C400082', 'Chemical') :: ['bortezomib', 'Bortezomib'] @entity1 :: ('9606', 'Species') :: ['patients']
@entity1749 :: (MESH:C400082,Chemical) :: ['Bortezomib']
