May 23, 2012

Durability of Antibody Removal Following Proteasome Inhibitor-Based Therapy

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Experience with proteasome inhibitors (PI) for treating antibody-mediated rejection (ABMR) and HLA antibody removal is increasing. However, the durability of the effects PI on HLA antibody removal is unknown. This study examines this question from a unique point of view due to the use of the PI bortezomib as either a combination therapy or a monotherapy in the patient cohort. The study followed 26 previously unsensitized kidney transplant recipients and PI treatment was administered post-transplant upon detection of donor specific antibody (DSA), prior to graft dysfunction. Patients were tested for DSA by Luminex single antigen beads during the first two years of treatment at 1, 3, 6, 9, 12, 18, and 24 months. Although it is a small study, it shows that 25/ 26 (96%) patients achieved at least a partial response to PI treatment. This study may provide some guidance to the use of PI in patients who develop de novo DSA post-transplant.

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