Your browser doesn't support javascript.
loading
Successful Treatment of Plasma Cell-Rich Acute Rejection Using Bortezomib: A Case Report.
Hashemi, Sara; Hod-Dvorai, Reut; Tong, Rebecca; Suo, Liye.
Afiliación
  • Hashemi S; Division of Nephrology and Transplantation The State University of New York Upstate Medical University (SUNY Upstate Medical University), Syracuse, New York 13210, USA.
  • Hod-Dvorai R; Department of Pathology The State University of New York Upstate Medical University (SUNY Upstate Medical University), Syracuse, New York 13210, USA.
  • Tong R; Department of Pathology The State University of New York Upstate Medical University (SUNY Upstate Medical University), Syracuse, New York 13210, USA.
  • Suo L; Department of Pathology The State University of New York Upstate Medical University (SUNY Upstate Medical University), Syracuse, New York 13210, USA.
Case Rep Transplant ; 2024: 9226321, 2024.
Article en En | MEDLINE | ID: mdl-39280853
ABSTRACT
Plasma cell-rich acute rejection (PCAR), a relatively rare subtype of acute allograft rejection, is usually associated with a significantly lower treatment response rate and a higher graft failure rate. PCAR is characterized by the presence of more than 10% of plasma cells out of all graft infiltrating cells, with approximately 40%-60% of PCAR resulting in graft failure within a year. Currently, there is no gold standard for the effective treatment of PCAR. This case report demonstrates the potential treatment effect of bortezomib in PCAR. A 37-year-old woman with reflux nephropathy received a kidney transplant from a brain-dead kidney donor. The patient presented with an acute kidney injury with a serum creatinine level over 4 mg/dL 4 months after the surgery. The allograft biopsy showed acute T cell-mediated rejection (TCMR), Grade IIA, plasma cell-rich variant. There were diffuse polyclonal plasma cells infiltrating the renal parenchyma with marked tubulitis and focal endarteritis. She received a methylprednisolone pulse of 500 mg daily x3, followed by thymoglobulin (rATG) at 4.2 mg/kg. However, a repeated biopsy after 2 months showed persistent plasma cells infiltrate with increased interstitial fibrosis with tubular atrophy. Then, the patient was given one cycle of bortezomib with a total of four subcutaneous injections and continued immunosuppressants of tacrolimus, mycophenolate mofetil, and prednisone. Following the treatment, the patient's serum creatinine level trended down to 2 mg/dL, and a second repeat biopsy after 4 months showed a significant treatment effect with complete resolution of interstitial inflammation and decreased chronicity. Bortezomib is a proteasome inhibitor that prevents cell proliferation by inducing apoptosis in plasma cells and has shown great promise as a therapeutic agent for multiple myeloma. Our case suggests that bortezomib can also be used as a potential therapeutic intervention for patients with PCAR.
Palabras clave
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Case Rep Transplant Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Case Rep Transplant Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos