Bortezomib combined with rituximab and plasmapheresis for the treatment of highly sensitized renal transplant candidates

doi:10.3969/j.issn.2095-4344.2013.05.007

Abstract

Abstract:

BACKGROUND: Highly sensitized is the barrier to successful renal transplantation. At present, the renal transplant desensitization treatment methods include the intravenous immunoglobulin, plasmapheresis and rabbit anti-human lymphocyte globulin, but the treatment effect is often unsatisfied.
OBJECTIVE: To perform the desensitization treatment through bortezomib and rituximab in order to find a treatment regimen with satisfactory results.
METHODS: One highly sensitized renal transplant candidate was selected to receive triple desensitization treatment. After plasmapheresis treatment, intravenous infusion of 500 mg rituximab was performed immediately. After infusion for 2 days, 1.3 mg/m2 bortezomib was injected at 1, 4, 8 and 11 days. The panel reactive antibody was observed during follow-up.
RESULTS AND CONCLUSION: During a nine-month follow-up period, cytotoxic panel reactive antibody decreased from 92% to17%. The patient represented no adverse effects. Our initial experience suggests that triple desensitization treatment of plasmapheresis, rituximab and bortezomib was effective to reduce circulating antibodies against human leucocyte antigen. Bortezomib may be useful in desensitization protocols.

Key words: organ transplantation, renal transplantation, reactive antibody, desensitization, bortezomib, chronic glomerulonephritis, rituximab monoclonal antibody, immunoglobulin, rabbit anti-human lymphocyte globulin, plasmapheresis, specific antibodies

CLC Number:

R318

Hu Jian-min, Zhao Ming, Li Min, Guo Ying, Chen Hua, Liu Yong-guang. Bortezomib combined with rituximab and plasmapheresis for the treatment of highly sensitized renal transplant candidates[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(5): 805-810.

Figures/Tables 1

本次实验选择单个循环的硼替佐米对高致敏等待肾移植患者行脱敏治疗，联合血浆置换和利妥昔单抗，该方案理论基础是：硼替佐米清除直接产生抗体的浆细胞，利妥昔单抗针对未成熟B细胞、成熟B细胞和记忆B细胞，血浆置换清除预存抗体，多层次多角度脱敏治疗，2周内群体反应性抗体得到明显下降，随访9个月，群体反应性抗体仍继续下降无反弹，取得了良好的疗效，提示硼替佐米对高致敏等待肾移植患者脱敏治疗效果好，脱敏持续时间长,但脱敏治疗对肾移植后急性排斥反应的预防和及其长期疗效需进一步观察。总之，硼替佐米对高致敏等待肾移植患者脱敏治疗的效果和既往的研究一样[22-26]，受限于无对照观察和样本量小，但实验设计的硼替佐米联合利妥昔单抗和血浆置换三联脱敏方案的初步研究将为以后进一步的深入研究提供基础。致谢：该课题得到了南方医科大学珠江医院器官移植科全体医护人员的鼎力配合，在治疗方案的实施、临床数据的获取方面给予了极大的支持，在此表示感谢。作者贡献：胡建敏和赵明对该文进行实验设计，郭颖、李民、刘永光负责实施该课题治疗方案，陈桦进行实验评估和资料收集，由胡建敏撰写该文，陈桦、赵明审校，胡建敏和陈桦对文章负责。利益冲突：课题未涉及任何厂家及相关雇主或其他经济组织直接或间接的经济或利益的赞助。伦理要求：参与实验的患病个体对实验过程完全知情同意，在充分了解本治疗方案的前提下签署“知情同意书”；干预及治疗方案获医院伦理委员会批准。作者声明：文章为原创作品，数据准确，内容不涉及泄密，无一稿两投，无抄袭，无内容剽窃，无作者署名争议，无与他人课题以及专利技术的争执，内容真实，文责自负。"

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